Chapter 422
2022 -- H 7503 SUBSTITUTE B AS AMENDED
Enacted 06/30/2022

A N   A C T
RELATING TO INSURANCE

Introduced By: Representatives Amore, and Henries

Date Introduced: February 16, 2022

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 27-18-90. 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
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 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. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
Corporations" is hereby amended by adding thereto the following section:
     27-19-81 27-19-82. 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 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. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
Corporations" is hereby amended by adding thereto the following section:
     27-20-77 27-20-78. 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 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. Chapter 27-41 of the General Laws entitled "Health Maintenance
Organizations" is hereby amended by adding thereto the following section:
     27-41-94 27-41-95. 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 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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LC004745/SUB B
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