SESSION OF 2022
SUPPLEMENTAL NOTE ON HOUSE BILL NO. 2110
As Amended by House Committee on Insurance
and Pensions

Brief*
HB 2110, as amended, would require, for the next State
Employee Health Plan (SEHP) coverage year (Plan Year
2023), the State Employees Health Care Commission to
provide coverage for the diagnosis and prescribed treatment
for pediatric acute-onset neuropsychiatric syndrome (PANS)
and pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections (PANDAS), for the
purposes of studying the utilization and cost of such
coverage.
The bill would also require the Commission, pursuant to
the “test track” or pilot program requirements in the Insurance
Code (KSA 40-2249a), to submit a report to the President of
the Senate and the Speaker of the House of Representatives
on or before March 1, 2024, which includes the following
information pertaining to the mandated coverage for PANS
and PANDAS provided during the 2023 Plan Year:
● The impact that the mandated coverage for PANS
and PANDAS required by the bill has had on the
SEHP;
● Data on the utilization of coverage for PANS and
PANDAS by covered individuals and the cost of
providing such coverage; and
● A recommendation whether such mandated
coverage should continue in the SEHP or whether
additional utilization and cost data is required.
____________________
*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
http://www.kslegislature.org
 At the next legislative session following receipt of the
report, the bill would authorize the Legislature to consider
whether to require coverage for PANS and PANDAS in any
individual or group health insurance policy, medical service
plan, contract, hospital service corporation contract, hospital
and medical service corporation contract, fraternal benefit
society, or health maintenance organization that provides
coverage for accident and health services and that is
delivered, issued for delivery, amended, or renewed in this
state on or after July 1, 2025.

Background
The bill was introduced by the House Committee on
Insurance and Pensions at the request of Representative
Eplee.
[Note: During the 2020 Interim, the House Committee on
Health and Human Services was authorized to meet and
study the topic of PANS/PANDAS. The Committee’s report
noted testimony presented and commented on the challenges
of enacting state insurance mandates. The Committee
recommended the 2021 Legislature review the insurance
implications of any proposed payment mandate on both the
public and private payer communities.]

House Committee on Insurance and Pensions
In the House Committee hearing on February 10, 2021,
Representative Eplee, a clinical professor with the UCLA
School of Medicine, a psychiatrist and parent of a child with
PANS/PANDAS, and a social worker and parent of a child
who has recovered from PANS provided proponent
testimony. The proponents addressed the efforts to bring
awareness to the symptoms and treatment of
PANS/PANDAS, as the disorders and presenting symptoms
are often misunderstood and the definitive treatment is
expensive. PANS is characterized, for example, as an abrupt

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onset of obsessive-compulsive disorders or a severe or
restrictive eating disorder, and may also present with
neurological disorder (e.g., tics), with at least two of seven
symptoms presenting (e.g., anxiety, behavioral regression,
and sensory or motor abnormalities). Proponents discussed
the range of treatment options and the benefits of treatment
regimens that use IVIG (a typical infusion costs between
$3,000 and $5,000 per infusion). A parent addressed her
child’s diagnosis, from sudden onset at age 9 and the
challenges in securing diagnosis and treatment, to the
recovery afforded by intravenous immunoglobulin (IVIg)
treatments. Proponents indicated the use of the test track for
this proposed mandated coverage would allow children and
families to access medical treatments, as well as aid in cost
benefit analysis for consideration of expansion of the
mandate statewide.
A representative of Blue Cross Blue Shield of Kansas
(BCBSKS) provided neutral testimony indicating appreciation
for consideration of the proposed health insurance mandate
as a pilot project. The representative noted the requirements
of KSA 40-2248 and 40-2249 for information on the impact of
a mandate have not been fulfilled and it is necessary for the
Committee to have access to an impact report, which would
assess the social and fiscal effect of the new mandate. Such
report would provide additional information on the public
benefits of the mandate and the associated costs. The
representative highlighted treatments BCBSKS covers for
PANS/PANDAS treatments, including antibiotics, prednisone,
and autism applied behavioral analysis therapy. The
representative stated BCBSKS and many insurers, however,
consider IVIg to be investigational or experimental as a
treatment for PANS/PANDAS.
In March 2021, the Committee submitted a request to
the Director of the State Employee Health Plan seeking input
regarding the information presented in the fiscal note for the
bill and requesting further information regarding both the
financial and social impact factors, as outlined in Kansas law,

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associated with the diagnosis and prescribed treatment of
PANS/PANDAS.
On February 7, 2022, the House Committee held an
informational update on the topic of HB 2110. An analyst with
the Kansas Legislative Research Department provided
background information on the bill, the test track
requirements in law for proposed mandated benefit and
provider coverages, and the Committee request to the SEHP.
A representative of the Segal Company provided a review of
the report submitted to the Committee pursuant to its March
2021 request (annual cost estimates are noted below). The
Committee also received updates from representative
conferees to the bill. Representative Eplee and a parent
spoke about bringing awareness to PANS/PANDAS in
Kansas and the need to provide access to timely, but often
expensive, treatment that is often not covered by insurance.
The representative for health insurer Cigna supported the
bill’s conformation with the state health insurance mandates’
test track process. The representative noted the proposed
mandate for coverage of PANS/PANDAS treatment would
exceed the Kansas Essential Health Benefits, and these
costs for enrollees in the Exchange would need to be
determined and paid annually by the State.
The House Committee amendments update the plan
year and reporting dates specified in the bill.

Fiscal Information (2021)
According to the February 2021 fiscal note prepared by
the Division of the Budget on the bill, as introduced, the
Department of Administration estimates enactment of the bill
would increase costs to the SEHP by $242,236 from special
revenue funds in FY 2022. The estimate assumes a first-year
cost increase of $484,471. However, because the bill’s
provisions would not go into effect until January 1, 2022, only
half the annual cost would apply to FY 2022. The Department
estimates the cost would increase to $511,117 in FY 2023

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which assumes a cost and usage increase of $26,646 or 5.50
percent. [Note: The bill, as amended by House Committee,
would apply to the plan year beginning on January 1, 2023.]
The Kansas Insurance Department indicates enactment
of the bill would not have a fiscal effect on Department
operations. Any fiscal effect associated with the bill is not
reflected in The FY 2022 Governor’s Budget Report.

Fiscal Information (2022, Segal Company Report)
The Segal Company report indicated the impact to
claims cost and administrative expenses for the SEHP is
estimated to be minimal. The report provided updated
treatment estimates, which included a narrower count of
enrolled children (11,904 enrolled children, from ages 3 to 14)
on a range of prevalence estimates (from 0.15 percent to
0.50 percent) based on a combination of treatments
according to condition severity.
The estimated annual cost range for PANS/PANDAS
treatment, using this treatment cost model, is $211,150 to
$704,500, or 0.06 percent to 0.19 percent of total projected
plan costs.
Estimated Costs of Providing PANS/PANDAS Coverage
Estimated Percentage
Avg. Cost Annual of Total
Prevalence Enrollment, Prevalence of Treatment Projected
Percentage Ages 3 to 14 Count Treatment Costs Plan Cost
0.50% 11,904 60 $11,835 $704,500 0.19%
(1 in 200 (11,904*.0.50%)
rate)
0.15% 11,904 18 $11,835 $211,150 0.06%
(11,904*0.15%)
Source: Segal Consulting report, on behalf of the State Employees Health Care
Commission, to the House Committee (January 2022)
Insurance; State Employee Health Plan, pediatric acute-onset neuropsychiatric
syndrome; PANS; pediatric autoimmune neuropsychiatric disorders associated with
streptococcal infections; PANDAS

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