CSHB 292(L&C): "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(L&C) 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 nationally recognized clinical practice treatment guidelines for 13 diagnosis and treatment of pediatric autoimmune neuropsychiatric disorders associated 14 with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome that 15 are accessible for medical professionals and are based on evidence of positive patient 16 outcomes; 17 (3) require a trial of therapies that treat only neuropsychiatric 18 symptoms before authorizing coverage of immunomodulating therapies for the 19 treatment of pediatric autoimmune neuropsychiatric disorders associated with 20 streptococcal infections and pediatric acute-onset neuropsychiatric syndrome; 21 (4) deny coverage for out-of-state treatment if the service is not 22 available in the state; or 23 (5) deny coverage based on age. 24 (c) Nothing in this section prevents an insurer from requesting treatment notes, 25 the anticipated duration of treatment, or expected outcomes, or from undertaking usual 26 and customary procedures, including prior authorization, to determine the 27 appropriateness of and medical necessity for treatment of pediatric autoimmune 28 neuropsychiatric disorders associated with streptococcal infections and pediatric 29 acute-onset neuropsychiatric syndrome, if the appropriate and medical necessity 30 determinations are made in the same manner as those determinations are made for the 31 treatment of any other illness, condition, or disorder covered by the health care
01 insurance plan. 02 (d) Coverage under this section may not be more restrictive than or separate 03 from coverage provided for any other illness, condition, or disorder for purposes of 04 determining deductibles, benefit year or lifetime durational limits, benefit year or 05 lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance 06 factors, and benefit year maximum for deductibles and copayments and coinsurance 07 factors. 08 (e) In this section, 09 (1) "nationally recognized clinical practice treatment guidelines" 10 means evidence-based clinical practice guidelines developed by a nationally 11 recognized independent organization or medical professional society using a 12 transparent methodology and reporting structure with a conflict of interest policy and 13 for which the standards of care are informed by recommendations intended to 14 optimize patient care, systematic review of evidence, and assessment of the benefits 15 and risks of alternative care options; 16 (2) "pediatric acute-onset neuropsychiatric syndrome" means a 17 clinically defined disorder characterized by the sudden onset of obsessive-compulsive 18 symptoms or eating restrictions, associated with acute behavioral deterioration in at 19 least two designated domains with comorbid symptoms that may include anxiety, 20 sensory amplification or motor abnormalities, behavioral regression, deterioration in 21 school performance, mood disorder, urinary symptoms, or sleep disturbances; 22 (3) "pediatric autoimmune neuropsychiatric disorders associated with 23 streptococcal infection" means a subset of pediatric acute-onset neuropsychiatric 24 syndrome that is usually accompanied by similar comorbid symptoms found in 25 pediatric acute-onset neuropsychiatric syndrome and has the following five distinct 26 criteria for diagnosis: 27 (A) abrupt obsessive-compulsive symptoms or dramatic and 28 disabling tics; 29 (B) a relapsing-remitting, episodic symptom course; 30 (C) young age at onset; 31 (D) presence of neurological abnormalities; and
01 (E) temporal association between symptom onset and group A 02 streptococcal infection. 03 * Sec. 2. AS 47.07.030(b) is amended to read: 04 (b) In addition to the mandatory services specified in (a) of this section and the 05 services provided under (d) of this section, the department may offer only the 06 following optional services: case management services for traumatic or acquired brain 07 injury; case management and nutrition services for pregnant women; personal care 08 services in a recipient's home; emergency hospital services; long-term care 09 noninstitutional services; medical supplies and equipment; advanced practice 10 registered nurse services; clinic services; rehabilitative services for children eligible 11 for services under AS 47.07.063, substance abusers, and emotionally disturbed or 12 chronically mentally ill adults; targeted case management services; inpatient 13 psychiatric facility services for individuals 65 years of age or older and individuals 14 under 21 years of age; psychologists' services; clinical social workers' services; marital 15 and family therapy services; professional counseling services; midwife services; 16 prescribed drugs; physical therapy; occupational therapy; chiropractic services; low- 17 dose mammography screening, as defined in AS 21.42.375(e); treatment of pediatric 18 autoimmune neuropsychiatric disorders associated with streptococcal infections 19 and pediatric acute-onset neuropsychiatric syndrome as covered in AS 21.42.450; 20 hospice care; treatment of speech, hearing, and language disorders; adult dental and 21 dental hygiene services; prosthetic devices; [AND] eyeglasses; optometrists' services; 22 intermediate care facility services, including intermediate care facility services for 23 persons with intellectual and developmental disabilities; skilled nursing facility 24 services for individuals under 21 years of age; and reasonable transportation to and 25 from the point of medical care. 26 * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 27 read: 28 MEDICAID STATE PLAN FEDERAL APPROVAL. To the extent necessary to 29 implement sec. 2 of this Act, the Department of Health shall amend and submit to the United 30 States Department of Health and Human Services for approval the state plan for medical 31 assistance coverage consistent with AS 47.07.030(b), as amended by sec. 2 of this Act.
01 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 02 read: 03 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 04 only if, on or before January 1, 2027, the United States Department of Health and Human 05 Services 06 (1) approves the amendment to the state plan for medical assistance coverage 07 under AS 47.07.030(b); or 08 (2) determines that approval of the amendment to the state plan for medical 09 assistance coverage under AS 47.07.030(b) is not necessary. 10 (b) The commissioner of health shall notify the revisor of statutes in writing within 30 11 days after the United States Department of Health and Human Services approves the 12 amendment to the state plan or determines that approval is not necessary under this section. 13 * Sec. 5. If sec. 2 of this Act takes effect, it takes effect on the day after the United States 14 Department of Health and Human Services approves the amendment submitted under sec. 3 15 of this Act or determines that approval of the amendment is not necessary. 16 * Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2027.