2023 -- H 5256

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LC000795

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Dawson, Kazarian, Carson, McGaw, Finkelman, Knight,
Shanley, O'Brien, McEntee, and Caldwell

     Date Introduced: January 27, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-90 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-90. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. [Expires December 31, 2025] 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 healthcare 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

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 2. Section 27-19-82 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-82. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. [Expires December 31, 2025.] 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

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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 healthcare 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

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. Section 27-20-78 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-78. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. [Expires December 31, 2025.] 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

LC000795 - Page 3 of 6

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 healthcare 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

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. Section 27-41-95 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-95. Mandatory coverage for treatment of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome. [Expires December 31, 2025.] 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

LC000795 - Page 4 of 6

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 healthcare 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

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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LC000795

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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 remove the sunset provision of all statutory law requiring coverage for the

treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal

infections and pediatric acute onset neuropsychiatric syndrome, thus requiring insurance coverage

to continue beyond December 31, 2025.

     This act would take effect upon passage.

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LC000795

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