2022 -- H 7503 SUBSTITUTE A

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LC004745/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Amore, and Henries

     Date Introduced: February 16, 2022

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-89. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of

intravenous immunoglobin therapy.

     (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall

be coded as autoimmune encephalitis until the American Medical Association and the Centers for

Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may

be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated

with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.

     (c) The health care benefits outlined in this section apply only to services delivered within

the state of Rhode Island; provided, that all health insurance carriers shall be required to provide

coverage for those benefits mandated by this section outside of the state of Rhode Island where it

can be established through a pre-authorization process that the required services are not available

in the state of Rhode Island from a provider in the health insurance carrier's network.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-81. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of

intravenous immunoglobin therapy.

     (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall

be coded as autoimmune encephalitis until the American Medical Association and the Centers for

Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may

be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated

with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.

     (c) The health care benefits outlined in this section apply only to services delivered within

the state of Rhode Island; provided, that all health insurance carriers shall be required to provide

coverage for those benefits mandated by this section outside of the state of Rhode Island where it

can be established through a pre-authorization process that the required services are not available

in the state of Rhode Island from a provider in the health insurance carrier's network.

     (d) Each health insurance carrier shall collect and provide to the office of the health

insurance commissioner, in a form and frequency acceptable to the commissioner, information and

data reflecting the costs and the savings of adding the benefit coverage provided in this section. On

LC004745/SUB A - Page 2 of 6

or before January 1, 2025, the office of the health insurance commissioner shall report to the general

assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this

section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage

provided in this section produces a net savings to health insurance carriers and to policy holders.

     (e) This section shall sunset and be repealed effective December 31, 2025.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-77. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of

intravenous immunoglobin therapy.

     (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall

be coded as autoimmune encephalitis until the American Medical Association and the Centers for

Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may

be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated

with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.

     (c) The health care benefits outlined in this section apply only to services delivered within

the state of Rhode Island; provided, that all health insurance carriers shall be required to provide

coverage for those benefits mandated by this section outside of the state of Rhode Island where it

can be established through a pre-authorization process that the required services are not available

in the state of Rhode Island from a provider in the health insurance carrier's network.

     (d) Each health insurance carrier shall collect and provide to the office of the health

insurance commissioner, in a form and frequency acceptable to the commissioner, information and

data reflecting the costs and the savings of adding the benefit coverage provided in this section. On

or before January 1, 2025, the office of the health insurance commissioner shall report to the general

LC004745/SUB A - Page 3 of 6

assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this

section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage

provided in this section produces a net savings to health insurance carriers and to policy holders.

     (e) This section shall sunset and be repealed effective December 31, 2025.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-94. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of

intravenous immunoglobin therapy.

     (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall

be coded as autoimmune encephalitis until the American Medical Association and the Centers for

Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may

be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated

with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.

     (c) The health care benefits outlined in this section apply only to services delivered within

the state of Rhode Island; provided, that all health insurance carriers shall be required to provide

coverage for those benefits mandated by this section outside of the state of Rhode Island where it

can be established through a pre-authorization process that the required services are not available

in the state of Rhode Island from a provider in the health insurance carrier's network.

     (d) Each health insurance carrier shall collect and provide to the office of the health

insurance commissioner, in a form and frequency acceptable to the commissioner, information and

data reflecting the costs and the savings of adding the benefit coverage provided in this section. On

or before January 1, 2025, the office of the health insurance commissioner shall report to the general

assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this

LC004745/SUB A - Page 4 of 6

section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage

provided in this section produces a net savings to health insurance carriers and to policy holders.

     (e) This section shall sunset and be repealed effective December 31, 2025.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would require coverage for the treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin

therapy.

     This act would take effect upon passage.

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LC004745/SUB A

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