Amends TCA Title 8; Title 56 and Title 71.
Tennessee HB0411, also known as "Lucca's Law," authorizes the division of TennCare to require group health insurance contracts and policies issued by managed care organizations (MCOs) to provide coverage for physician-prescribed treatments deemed medically necessary for pediatric autoimmune neuropsychiatric disorders associated with PANDAS and PANS, effective January 1, 2026. Key provisions include coverage for various treatments such as antibiotics and behavioral therapies, while ensuring that coverage cannot be denied based on previous treatments or diagnoses. The bill also establishes coding guidelines for billing purposes until specific codes for PANDAS and PANS are created.
Tennessee HB0411, also known as "Lucca's Law," authorizes the division of TennCare to require group health insurance contracts and policies issued by managed care organizations (MCOs) to provide coverage for physician-prescribed treatments deemed medically necessary for pediatric autoimmune neuropsychiatric disorders associated with PANDAS and PANS, effective January 1, 2026. Key provisions include coverage for various treatments such as antibiotics and behavioral therapies, while ensuring that coverage cannot be denied based on previous treatments or diagnoses. The bill also establishes coding guidelines for billing purposes until specific codes for PANDAS and PANS are created.
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