SB 71
Requiring coverage for certain pediatric autoimmune neuropsychiatric disorders
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- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill requires West Virginia’s Public Employees Insurance Act (PEIA), Medicaid, and other health insurance plans to cover treatment for specific pediatric autoimmune neuropsychiatric disorders, including those associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. It mandates that healthcare providers obtain prior authorization for these treatments, ensuring that all other available treatments have been exhausted first. The bill takes effect January 1, 2027.
Key provisions
- Requires coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.
- Requires coverage for treatment of pediatric acute onset neuropsychiatric syndrome.
- Mandates prior authorization for treatment of these disorders.
- Requires physicians to demonstrate that all other treatments have been exhausted before authorization is granted.
- Applies to PEIA, Medicaid, and other health insurance plans.
- Effective date of January 1, 2027.
Who is affected
- West Virginia Public Employees Insurance Act (PEIA) beneficiaries
- Medicaid recipients
- Individuals covered by other health insurance plans in West Virginia
- Healthcare providers treating pediatric autoimmune neuropsychiatric disorders
- Parents and guardians of children with these disorders
Notable changes
- Introduces specific coverage requirements for pediatric autoimmune neuropsychiatric disorders.
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