2021 -- S 0646

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LC002393

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO INSURANCE

     Introduced By: Senators Lawson, Lombardo, Seveney, Quezada, Miller, Sosnowski,
Cano, Pearson, Euer, and Burke

     Date Introduced: March 18, 2021

     Referred To: Senate 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:

     27-18-85. 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, 2022, 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) If, at any time, the secretary of the United States Department of Health and Human

Services, or its successor agency, promulgates rules or regulations to be published in the federal

register or publishes a comment in the federal register or issues an opinion, guidance, or other

action that would require the state, pursuant to any provision of the Patient Protection and

Affordable Care Act (Pub. L. 111-148), including, but not limited to, 42 U.S.C. 18031 (d)(3)(B) or

any successor provision, to defray the cost of any coverage for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome outlined in this section, then the requirement that an insurer cover

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome is inoperative other than any such coverage

authorized under § 1902 of the Social Security Act, (42 U.S.C. 1396a), and the state shall not

assume any obligation for the cost of coverage for pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome

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

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

     27-19-77. 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, 2022, 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

LC002393 - Page 2 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 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) If, at any time, the secretary of the United States Department of Health and Human

Services, or its successor agency, promulgates rules or regulations to be published in the federal

register or publishes a comment in the federal register or issues an opinion, guidance, or other

action that would require the state, pursuant to any provision of the Patient Protection and

Affordable Care Act (Pub. L. 111-148), including, but not limited to, 42 U.S.C. 18031 (d)(3)(B) or

any successor provision, to defray the cost of any coverage for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome outlined in this section, then the requirement that an insurer cover

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome is inoperative other than any such coverage

authorized under § 1902 of the Social Security Act, (42 U.S.C. 1396a), and the state shall not

assume any obligation for the cost of coverage for pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.

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

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

     27-20-73. 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, 2022, 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.

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     (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) If, at any time, the secretary of the United States Department of Health and Human

Services, or its successor agency, promulgates rules or regulations to be published in the federal

register or publishes a comment in the federal register or issues an opinion, guidance, or other

action that would require the state, pursuant to any provision of the Patient Protection and

Affordable Care Act (Pub. L. 111-148), including, but not limited to, 42 U.S.C. 18031 (d)(3)(B) or

any successor provision, to defray the cost of any coverage for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome outlined in this section, then the requirement that an insurer cover

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome is inoperative other than any such coverage

authorized under § 1902 of the Social Security Act, (42 U.S.C. 1396a), and the state shall not

assume any obligation for the cost of coverage for pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.

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

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

     27-41-90. 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

LC002393 - Page 4 of 6

any health insurance carrier, on or after January 1, 2022, 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) If, at any time, the secretary of the United States Department of Health and Human

Services, or its successor agency, promulgates rules or regulations to be published in the federal

register or publishes a comment in the federal register or issues an opinion, guidance, or other

action that would require the state, pursuant to any provision of the Patient Protection and

Affordable Care Act (Pub. L. 111-148), including, but not limited to, 42 U.S.C. 18031 (d)(3)(B) or

any successor provision, to defray the cost of any coverage for pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset

neuropsychiatric syndrome outlined in this section, then the requirement that an insurer cover

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and

pediatric acute onset neuropsychiatric syndrome is inoperative other than any such coverage

authorized under § 1902 of the Social Security Act, (42 U.S.C. 1396a), and the state shall not

assume any obligation for the cost of coverage for pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.

     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

***

     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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LC002393

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