CSHB 292(HSS): "An Act relating to insurance coverage for pediatric autoimmune neuropsychiatric disorders; relating to medical assistance for pediatric autoimmune neuropsychiatric disorders; and providing for an effective date."
00 CS FOR HOUSE BILL NO. 292(HSS) 01 "An Act relating to insurance coverage for pediatric autoimmune neuropsychiatric 02 disorders; relating to medical assistance for pediatric autoimmune neuropsychiatric 03 disorders; and providing for an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 21.42 is amended by adding a new section to read: 06 Sec. 21.42.450. Coverage for pediatric autoimmune neuropsychiatric 07 disorders. (a) A health care insurer that offers, issues for delivery, delivers, or renews 08 in this state a health care insurance plan shall provide coverage for the prophylaxis, 09 diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders 10 associated with streptococcal infections and pediatric acute-onset neuropsychiatric 11 syndrome. Coverage must include the current standard of care for treatment of 12 pediatric autoimmune neuropsychiatric disorders associated with streptococcal 13 infections and pediatric acute-onset neuropsychiatric syndrome, treatment using 14 antimicrobials, medication, behavioral therapies to manage neuropsychiatric
01 symptoms, immunomodulating medicines, plasma exchange, and intravenous 02 immunoglobulin therapy. 03 (b) An insurer may not 04 (1) deny or delay the coverage required under this section because the 05 enrollee previously received treatment, including the same or similar treatment, for the 06 conditions listed in this section or because the enrollee was diagnosed with or received 07 treatment for the condition under a different diagnostic name, including autoimmune 08 encephalopathy; 09 (2) limit coverage for immunomodulating therapy for the treatment of 10 pediatric autoimmune neuropsychiatric disorders associated with streptococcal 11 infections and pediatric acute-onset neuropsychiatric syndrome in a manner that is 12 inconsistent with the treatment guidelines developed by a consortium convened for the 13 purposes of researching, identifying, and publishing best practice standards for 14 diagnosis and treatment of pediatric autoimmune neuropsychiatric disorders associated 15 with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome that 16 are accessible for medical professionals and are based on evidence of positive patient 17 outcomes; 18 (3) require a trial of therapies that treat only neuropsychiatric 19 symptoms before authorizing coverage of immunomodulating therapies for the 20 treatment of pediatric autoimmune neuropsychiatric disorders associated with 21 streptococcal infections and pediatric acute-onset neuropsychiatric syndrome; 22 (4) deny coverage for out-of-state treatment if the service is not 23 available in the state; or 24 (5) deny coverage based on age. 25 (c) Nothing in this section prevents an insurer from requesting treatment notes, 26 the anticipated duration of treatment, or expected outcomes, or from undertaking usual 27 and customary procedures, including prior authorization, to determine the 28 appropriateness of and medical necessity for treatment of pediatric autoimmune 29 neuropsychiatric disorders associated with streptococcal infections and pediatric 30 acute-onset neuropsychiatric syndrome, if the appropriate and medical necessity 31 determinations are made in the same manner as those determinations are made for the
01 treatment of any other illness, condition, or disorder covered by the health benefit 02 plan. 03 (d) Coverage under this section may not be more restrictive than or separate 04 from coverage provided for any other illness, condition, or disorder for purposes of 05 determining deductibles, benefit year or lifetime durational limits, benefit year or 06 lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance 07 factors, and benefit year maximum for deductibles and copayments and coinsurance 08 factors. 09 (e) In this section, 10 (1) "pediatric acute-onset neuropsychiatric syndrome" means a 11 clinically defined disorder characterized by the sudden onset of obsessive-compulsive 12 symptoms or eating restrictions, associated with acute behavioral deterioration in at 13 least two designated domains with comorbid symptoms that may include anxiety, 14 sensory amplification or motor abnormalities, behavioral regression, deterioration in 15 school performance, mood disorder, urinary symptoms, or sleep disturbances; 16 (2) "pediatric autoimmune neuropsychiatric disorders associated with 17 streptococcal infection" means a subset of pediatric acute-onset neuropsychiatric 18 syndrome that is usually accompanied by similar comorbid symptoms found in 19 pediatric acute-onset neuropsychiatric syndrome and has the following five distinct 20 criteria for diagnosis: 21 (A) abrupt obsessive-compulsive symptoms or dramatic and 22 disabling tics; 23 (B) a relapsing-remitting, episodic symptom course; 24 (C) young age at onset; 25 (D) presence of neurological abnormalities; and 26 (E) temporal association between symptom onset and group A 27 streptococcal infection. 28 * Sec. 2. AS 47.07.030(b) is amended to read: 29 (b) In addition to the mandatory services specified in (a) of this section and the 30 services provided under (d) of this section, the department may offer only the 31 following optional services: case management services for traumatic or acquired brain
01 injury; case management and nutrition services for pregnant women; personal care 02 services in a recipient's home; emergency hospital services; long-term care 03 noninstitutional services; medical supplies and equipment; advanced practice 04 registered nurse services; clinic services; rehabilitative services for children eligible 05 for services under AS 47.07.063, substance abusers, and emotionally disturbed or 06 chronically mentally ill adults; targeted case management services; inpatient 07 psychiatric facility services for individuals 65 years of age or older and individuals 08 under 21 years of age; psychologists' services; clinical social workers' services; marital 09 and family therapy services; professional counseling services; midwife services; 10 prescribed drugs; physical therapy; occupational therapy; chiropractic services; low- 11 dose mammography screening, as defined in AS 21.42.375(e); treatment of pediatric 12 autoimmune neuropsychiatric disorders associated with streptococcal infections 13 and pediatric acute-onset neuropsychiatric syndrome as covered in AS 21.42.450; 14 hospice care; treatment of speech, hearing, and language disorders; adult dental and 15 dental hygiene services; prosthetic devices; [AND] eyeglasses; optometrists' services; 16 intermediate care facility services, including intermediate care facility services for 17 persons with intellectual and developmental disabilities; skilled nursing facility 18 services for individuals under 21 years of age; and reasonable transportation to and 19 from the point of medical care. 20 * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 21 read: 22 MEDICAID STATE PLAN FEDERAL APPROVAL. To the extent necessary to 23 implement sec. 2 of this Act, the Department of Health shall amend and submit to the United 24 States Department of Health and Human Services for approval the state plan for medical 25 assistance coverage consistent with AS 47.07.030(b), as amended by sec. 2 of this Act. 26 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 27 read: 28 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 29 only if, on or before January 1, 2027, the United States Department of Health and Human 30 Services 31 (1) approves the amendment to the state plan for medical assistance coverage
01 under AS 47.07.030(b); or 02 (2) determines that approval of the amendment to the state plan for medical 03 assistance coverage under AS 47.07.030(b) is not necessary. 04 (b) The commissioner of health shall notify the revisor of statutes in writing within 30 05 days after the United States Department of Health and Human Services approves the 06 amendment to the state plan or determines that approval is not necessary under this section. 07 * Sec. 5. If sec. 2 of this Act takes effect, it takes effect on the day after the United States 08 Department of Health and Human Services approves the amendment submitted under sec. 3 09 of this Act or determines that approval of the amendment is not necessary. 10 * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2027.