2022 -- S 2203 SUBSTITUTE A | |
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LC003422/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 | |
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Introduced By: Senators Lawson, DiMario, Burke, Murray, Cano, Quezada, and | |
Date Introduced: February 08, 2022 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance |
2 | Policies" is hereby amended by adding thereto the following section: |
3 | 27-18-89. Mandatory coverage for treatment of pediatric autoimmune |
4 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
5 | neuropsychiatric syndrome. |
6 | (a) Every group health insurance contract, or every group hospital or medical expense |
7 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
8 | any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of |
9 | pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and |
10 | pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of |
11 | intravenous immunoglobin therapy. |
12 | (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders |
13 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall |
14 | be coded as autoimmune encephalitis until the American Medical Association and the Centers for |
15 | Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune |
16 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
17 | neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders |
18 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may |
19 | be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated |
| |
1 | with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. |
2 | (c) The health care benefits outlined in this section apply only to services delivered within |
3 | the state of Rhode Island; provided, that all health insurance carriers shall be required to provide |
4 | coverage for those benefits mandated by this section outside of the state of Rhode Island where it |
5 | can be established through a pre-authorization process that the required services are not available |
6 | in the state of Rhode Island from a provider in the health insurance carrier's network. |
7 | (d) Each health insurance carrier shall collect and provide to the office of the health |
8 | insurance commissioner, in a form and frequency acceptable to the commissioner, information and |
9 | data reflecting the costs and the savings of adding the benefit coverage provided in this section. On |
10 | or before January 1, 2025, the office of the health insurance commissioner shall report to the general |
11 | assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this |
12 | section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage |
13 | provided in this section produces a net savings to health insurance carriers and to policy holders. |
14 | SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service |
15 | Corporations" is hereby amended by adding thereto the following section: |
16 | 27-19-81. Mandatory coverage for treatment of pediatric autoimmune |
17 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
18 | neuropsychiatric syndrome. |
19 | (a) Every group health insurance contract, or every group hospital or medical expense |
20 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
21 | any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of |
22 | pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and |
23 | pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of |
24 | intravenous immunoglobin therapy. |
25 | (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders |
26 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall |
27 | be coded as autoimmune encephalitis until the American Medical Association and the Centers for |
28 | Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune |
29 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
30 | neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders |
31 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may |
32 | be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated |
33 | with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. |
34 | (c) The health care benefits outlined in this section apply only to services delivered within |
| LC003422/SUB A - Page 2 of 5 |
1 | the state of Rhode Island; provided, that all health insurance carriers shall be required to provide |
2 | coverage for those benefits mandated by this section outside of the state of Rhode Island where it |
3 | can be established through a pre-authorization process that the required services are not available |
4 | in the state of Rhode Island from a provider in the health insurance carrier's network. |
5 | (d) Each health insurance carrier shall collect and provide to the office of the health |
6 | insurance commissioner, in a form and frequency acceptable to the commissioner, information and |
7 | data reflecting the costs and the savings of adding the benefit coverage provided in this section. On |
8 | or before January 1, 2025, the office of the health insurance commissioner shall report to the general |
9 | assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this |
10 | section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage |
11 | provided in this section produces a net savings to health insurance carriers and to policy holders. |
12 | SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service |
13 | Corporations" is hereby amended by adding thereto the following section: |
14 | 27-20-77. Mandatory coverage for treatment of pediatric autoimmune |
15 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
16 | neuropsychiatric syndrome. |
17 | (a) Every group health insurance contract, or every group hospital or medical expense |
18 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
19 | any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of |
20 | pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and |
21 | pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of |
22 | intravenous immunoglobin therapy. |
23 | (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders |
24 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall |
25 | be coded as autoimmune encephalitis until the American Medical Association and the Centers for |
26 | Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune |
27 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
28 | neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders |
29 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may |
30 | be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated |
31 | with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. |
32 | (c) The health care benefits outlined in this section apply only to services delivered within |
33 | the state of Rhode Island; provided, that all health insurance carriers shall be required to provide |
34 | coverage for those benefits mandated by this section outside of the state of Rhode Island where it |
| LC003422/SUB A - Page 3 of 5 |
1 | can be established through a pre-authorization process that the required services are not available |
2 | in the state of Rhode Island from a provider in the health insurance carrier's network. |
3 | (d) Each health insurance carrier shall collect and provide to the office of the health |
4 | insurance commissioner, in a form and frequency acceptable to the commissioner, information and |
5 | data reflecting the costs and the savings of adding the benefit coverage provided in this section. On |
6 | or before January 1, 2025, the office of the health insurance commissioner shall report to the general |
7 | assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this |
8 | section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage |
9 | provided in this section produces a net savings to health insurance carriers and to policy holders. |
10 | SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance |
11 | Organizations" is hereby amended by adding thereto the following section: |
12 | 27-41-94. Mandatory coverage for treatment of pediatric autoimmune |
13 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
14 | neuropsychiatric syndrome. |
15 | (a) Every group health insurance contract, or every group hospital or medical expense |
16 | insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by |
17 | any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of |
18 | pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and |
19 | pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of |
20 | intravenous immunoglobin therapy. |
21 | (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders |
22 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall |
23 | be coded as autoimmune encephalitis until the American Medical Association and the Centers for |
24 | Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune |
25 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
26 | neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders |
27 | associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may |
28 | be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated |
29 | with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. |
30 | (c) The health care benefits outlined in this section apply only to services delivered within |
31 | the state of Rhode Island; provided, that all health insurance carriers shall be required to provide |
32 | coverage for those benefits mandated by this section outside of the state of Rhode Island where it |
33 | can be established through a pre-authorization process that the required services are not available |
34 | in the state of Rhode Island from a provider in the health insurance carrier's network. |
| LC003422/SUB A - Page 4 of 5 |
1 | (d) Each health insurance carrier shall collect and provide to the office of the health |
2 | insurance commissioner, in a form and frequency acceptable to the commissioner, information and |
3 | data reflecting the costs and the savings of adding the benefit coverage provided in this section. On |
4 | or before January 1, 2025, the office of the health insurance commissioner shall report to the general |
5 | assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this |
6 | section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage |
7 | provided in this section produces a net savings to health insurance carriers and to policy holders. |
8 | SECTION 5. This act shall take effect upon passage. |
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LC003422/SUB A | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE | |
*** | |
1 | This act would require coverage for the treatment of pediatric autoimmune |
2 | neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset |
3 | neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin |
4 | therapy. |
5 | This act would take effect upon passage. |
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LC003422/SUB A | |
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