00                             HOUSE BILL NO. 292                                                                          
01 "An Act relating to insurance coverage for pediatric autoimmune neuropsychiatric                                        
02 disorders; and providing for an effective date."                                                                        
03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
04    * Section 1. AS 21.42 is amended by adding a new section to read:                                                  
05 Sec. 21.42.450. Coverage for pediatric autoimmune neuropsychiatric                                                    
06 disorders. (a) A health care insurer that offers, issues for delivery, delivers, or renews                            
07 in this state a health care insurance plan shall provide coverage for the prophylaxis,                                  
08 diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders                                             
09 associated with streptococcal infections and pediatric acute-onset neuropsychiatric                                     
10       syndrome. Coverage must include treatment using antimicrobials, medication,                                       
11       behavioral therapies to manage neuropsychiatric symptoms, immunomodulating                                        
12       medicines, plasma exchange, and intravenous immunoglobulin therapy.                                               
13            (b)  An insurer may not                                                                                      
14                 (1)  deny or delay the coverage required under this section because the                                 
01 enrollee previously received treatment, including the same or similar treatment, for the                                
02 conditions listed in this section or because the enrollee was diagnosed with or received                                
03 treatment for the condition under a different diagnostic name, including autoimmune                                     
04       encephalopathy;                                                                                                   
05 (2)  limit coverage for immunomodulating therapy for the treatment of                                                   
06 pediatric autoimmune neuropsychiatric disorders associated with streptococcal                                           
07 infections and pediatric acute-onset neuropsychiatric syndrome in a manner that is                                      
08 inconsistent with the treatment guidelines developed by a consortium convened for the                                   
09 purposes of researching, identifying, and publishing best practice standards for                                        
10 diagnosis and treatment of pediatric autoimmune neuropsychiatric disorders associated                                   
11 with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome that                                  
12 are accessible for medical professionals and are based on evidence of positive patient                                  
13       outcomes;                                                                                                         
14 (3)  require a trial of therapies that treat only neuropsychiatric                                                      
15 symptoms before authorizing coverage of immunomodulating therapies for the                                              
16 treatment of pediatric autoimmune neuropsychiatric disorders associated with                                            
17       streptococcal infections and pediatric acute-onset neuropsychiatric syndrome;                                     
18 (4)  deny coverage for out-of-state treatment if the service is not                                                     
19       available in the state; or                                                                                        
20                 (5)  deny coverage based on age.                                                                        
21 (c)  Nothing in this section prevents an insurer from requesting treatment notes,                                       
22 the anticipated duration of treatment, or expected outcomes, or from undertaking usual                                  
23 and customary procedures, including prior authorization, to determine the                                               
24 appropriateness of and medical necessity for treatment of pediatric autoimmune                                          
25 neuropsychiatric disorders associated with streptococcal infections and pediatric                                       
26 acute-onset neuropsychiatric syndrome, if the appropriate and medical necessity                                         
27 determinations are made in the same manner as those determinations are made for the                                     
28 treatment of any other illness, condition, or disorder covered by the health benefit                                    
29       plan.                                                                                                             
30 (d)  Coverage under this section may not be more restrictive than or separate                                           
31 from coverage provided for any other illness, condition, or disorder for purposes of                                    
01 determining deductibles, benefit year or lifetime durational limits, benefit year or                                    
02 lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance                                
03 factors, and benefit year maximum for deductibles and copayments and coinsurance                                        
04       factors.                                                                                                          
05            (e)  In this section,                                                                                        
06 (1)  "pediatric acute-onset neuropsychiatric syndrome" means a                                                          
07 clinically defined disorder characterized by the sudden onset of obsessive-compulsive                                   
08 symptoms or eating restrictions, associated with acute behavioral deterioration in at                                   
09 least two designated domains with comorbid symptoms that may include anxiety,                                           
10 sensory amplification or motor abnormalities, behavioral regression, deterioration in                                   
11       school performance, mood disorder, urinary symptoms, or sleep disturbances;                                       
12 (2)  "pediatric autoimmune neuropsychiatric disorders associated with                                                   
13 streptococcal infection" means a subset of pediatric acute-onset neuropsychiatric                                       
14 syndrome that is usually accompanied by similar comorbid symptoms found in                                              
15 pediatric acute-onset neuropsychiatric syndrome and has the following five distinct                                     
16       criteria for diagnosis:                                                                                           
17 (A)  abrupt obsessive-compulsive symptoms or dramatic and                                                               
18            disabling tics;                                                                                              
19                      (B)  a relapsing-remitting, episodic symptom course;                                               
20                      (C)  young age at onset;                                                                           
21                      (D)  presence of neurological abnormalities; and                                                   
22 (E)  temporal association between symptom onset and group A                                                             
23            streptococcal infection.                                                                                     
24    * Sec. 2. This Act takes effect January 1, 2027.