Fiscal Note
Fiscal Services Division
SF 165 – Pediatric Autoimmune Neuropsychiatric Disorder, Insurance Coverage (LSB1084XS)
Staff Contact: Angel Banks-Adams (515.281.6301) angel.banks-adams@legis.iowa.gov
Fiscal Note Version – New
Description
Senate File 165 requires health insurance carriers that offer individual, group, or small group
contracts, policies, or plans in the State that provide for third-party payment or prepayment of
health or medical expenses to offer coverage for the diagnosis and treatment of PANS (pediatric
acute-onset neuropsychiatric syndrome) and PANDAS (pediatric autoimmune neuropsychiatric
disorders associated with streptococcal infections) to a covered individual who is age 18 or
younger, as recommended by a health care professional. The Bill also requires the Insurance
Division to adopt rules to administer the requirement for identified health insurance carriers.
The Bill is effective January 1, 2022.
Background
PANS, which can be caused by infections such as influenza and varicella, and PANDAS, which
is associated with streptococcal infections, may present in a neurologically severe manner that
is resistant or slow to respond to forms of treatment used in mild to moderate cases.
Intravenous immunoglobulin treatment (IVIG) or therapeutic plasma exchange may be clinically
indicated for these severe cases.
Assumptions
• The exact prevalence of PANS and PANDAS is currently unknown; however, it is estimated
that approximately 4.0% of individuals 18 years of age or younger have Obsessive-
Compulsive Disorder (OCD) and that approximately 1.0% of these OCD cases are due to
PANDAS/PANS. One estimate is that approximately 1 in 200 children has PANDAS/PANS.
• Approximately 13,400 children ages 18 and younger are covered under the State of Iowa
health insurance plan.
• The cost of IVIG, therapeutic plasma exchange, and other associated treatments is
estimated at $5,000 to $25,000 per case.
• Roughly 20.0% of PANDAS/PANS cases, per the incidence rate of associated behavioral
disorders, may present in a severe manner that is unresponsive to other treatments.
Fiscal Impact
The cost of SF 165 across all State funds ranges from approximately $65,000 to $350,000,
assuming 13 to 14 children covered by the State of Iowa health insurance plan have exhausted
other treatment protocols and are identified as candidates for IVIG or therapeutic plasma
exchange. There is no fiscal impact to the Department of Human Services or the Medicaid
program as Medicaid currently covers IVIG and therapeutic plasma exchange.
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Sources
Wellmark
Department of Human Services
/s/ Holly M. Lyons
March 3, 2021
Doc ID 1215544
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in
developing this fiscal note is available from the Fiscal Services Division of the Legislative Services
Agency upon request.
www.legis.iowa.gov
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