Amends TCA Title 8; Title 56 and Title 71.

This bill requires that every group health insurance contract, and every group hospital or medical expense insurance policy, plan, and group policy delivered, issued for delivery, amended or renewed in this state by a health insurance carrier, on or after January 1, 2025, must provide coverage for PANDAS and PANS. The coverage must include, but is not limited to, antibiotics, medication, behavioral therapies to manage neuropsychiatric symptoms, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy.<br /> <br /> This bill requires that benefits provided by these provisions must not be subject to a greater co-payment deductible, or coinsurance than another similar benefit provided by the insurer. This bill further requires that coverage authorization must be provided in a timely manner consistent with department of commerce and insurance rules for urgent treatments adopted pursuant to federal law. <br /> <br /> This bill prohibits a group or individual policy of accident and health insurance or managed care from denying or delaying coverage for medically necessary treatment provided for by this bill solely because the insured, enrollee, or beneficiary previously received treatment, including the same or similar treatment, for PANDAS or PANS, or because the insured, enrollee, or beneficiary has been diagnosed with or received treatment for their condition under a different diagnostic name, such as autoimmune encephalopathy. <br /> <br /> Instead, this bill requires that coverage of PANDAS and PANS must adhere to the treatment recommendations by a medical professional consortium convened for the purposes of researching, identifying, and publishing best practice standards for diagnosis and treatment of such disorders that are accessible for medical professionals and are based on evidence of positive patient outcomes. This bill prohibits that coverage for a form of medically necessary treatment from being limited over the lifetime of an insured, enrollee, beneficiary, or by the duration of a policy period.<br /> <br /> This bill requires that for billing and diagnosis purposes, PANDAS and PANS must be coded as autoimmune encephalitis until a specific code for PANDAS and PANS is established by the American Medical Association and the centers for medicare and medicaid services. <br />