August 9, 2022

Sen. Lawson and Rep. Amore’s legislation requiring insurance coverage for pediatric autoimmune neuropsychiatric disorders ceremonially signed into law

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State House – Legislation (2022-S 2203B, 2022-H 7503Baa) sponsored by Sen. Valarie J. Lawson (D-Dist. 14, East Providence) and Rep. Gregg Amore (D-Dist. 65, East Providence) which would require insurance coverage for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome was ceremonially signed into law today.

According to the National Institute of Mental Health, children may be diagnosed with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) when obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever. The symptoms are usually dramatic, happen “overnight and out of the blue,” and can include motor or vocal tics or both and obsessions, compulsions, or both. In addition to these symptoms, children may become moody or irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones.

“The stress and uncertainty that arises with PANDAS can be extremely challenging for children and their families. When compounded with treatment costs after a diagnosis is made, families who are affected by PANDAS are in need of serious help and support. This bill will make sure that children suffering from PANDAS get the medical help they need while also protecting the wallets and pocketbooks of their families,” said Senator Lawson.

“PANDAS can be extremely alarming and scary for children and their families, often leading them to a place of confusion, stress and anxiety. This bill will ensure that the necessary treatments are available to children and families affected by PANDAS without forcing them to cover the costs out of pocket, providing the health and financial relief that these families deserve,” said Representative Amore.

The bill would require that every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of PANDAS and pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin therapy.

The act would also require the Office of the Health Insurance Commissioner to collect information and data reflecting the costs and the savings of adding the benefit coverage provided in the legislation. On or before January 1, 2025, the Office of the Health Insurance Commissioner shall report to the General Assembly a cost-benefit analysis of the implementation of the benefit coverage. The intent of this cost-benefit analysis is to determine if adding the benefit coverage provided in this section produces a net savings to health insurance carriers and to policy holders.

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