HB 4197
Mandating health insurance coverage treatment of pediatric patients diagnoced with PANDAS or PANS
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
West Virginia House Bill 4197 aims to require health insurance plans to cover treatment for pediatric patients diagnosed with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome). The bill establishes definitions, clarifies coverage requirements, and outlines billing procedures, ensuring medically necessary treatments are accessible. It also includes provisions to prevent denial of coverage based on prior treatment or different diagnostic names.
Key provisions
- Requires health insurance plans to cover treatment for PANDAS and PANS.
- Defines key terms like ‘Managed Care Organization’ and ‘Medically Necessary’.
- Establishes billing procedures and clarifies treatment types (antibiotics, medication, therapies, etc.).
- Prohibits denial of coverage based on prior treatment or different diagnostic names.
- Requires insurance plans to adhere to treatment recommendations from a medical professional consortium.
- Specifies a temporary coding method (autoimmune encephalitis) until a dedicated code for PANDAS and PANS is created.
- Authorizes the Secretary of Health to create rules for implementation.
- Establishes a timeline for coverage implementation (January 1, 2027).
Who is affected
- Children diagnosed with PANDAS or PANS
- Parents or guardians of children with PANDAS or PANS
- Health insurance companies operating in West Virginia
- Healthcare providers treating PANDAS or PANS patients
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