AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES .

Permanent treatment coverage for affected children

Rhode Island makes required treatment coverage permanent for children with PANDAS or PANS, two pediatric neuropsychiatric disorders. The law takes effect upon passage and removes the December 31, 2025 coverage end date. Covered treatment includes intravenous immunoglobulin therapy. The requirement covers group health contracts, group hospital or medical expense policies, nonprofit hospital and medical service policies, and HMO plans. It applies to plans delivered, issued for delivery, or renewed in Rhode Island on or after January 1, 2023. Plans must cover out-of-state care when preapproval shows the service is unavailable from an in-network Rhode Island provider. Billing and diagnosis must use the autoimmune encephalitis code until the American Medical Association and Medicare/Medicaid agency create specific codes. Afterward, providers may use autoimmune encephalitis, PANDAS, or PANS codes. Insurers must report coverage costs and savings to Rhode Island’s health insurance commissioner. The commissioner’s cost-benefit report to lawmakers was due January 1, 2025, assessing net savings for insurers and policyholders.