The bill introduced on January 14, 2026, aims to amend the Code of West Virginia by adding a new section, 5-16B-6b, which mandates coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). It provides definitions for key terms such as "managed care organization" and "medically necessary," outlining the criteria that must be met for treatments to be considered medically necessary. The bill specifies that coverage must include various treatments such as antibiotics, behavioral therapies, and immunomodulating medicines, and it prohibits insurance plans from imposing higher co-payments or deductibles for these services compared to similar benefits.

Additionally, the bill ensures that coverage cannot be denied or delayed based on a recipient's previous treatment history or different diagnostic names for their condition. It establishes that PANDAS and PANS should be coded as autoimmune encephalitis for billing purposes until specific codes are assigned. The Secretary of the Department of Health and Human Resources is tasked with proposing rules necessary to implement these provisions. Overall, the bill seeks to enhance access to necessary medical treatments for children suffering from these disorders, ensuring that they receive timely and appropriate care.

Statutes affected:
Introduced Version: 5-16B-6b