Senate Bill #646 (2021)

AN ACT RELATING TO INSURANCE

Requires 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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  • 2021 – S 0646
  • 2021 – S 0646 SUBSTITUTE A
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  • LC002393
  • LC002393/SUB A
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  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • ____________
  • 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:
  • SECTION1.Chapter27-18 oftheGeneral Lawsentitled"AccidentandSicknessInsurance 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 assumeanyobligationforthecost ofcoverageforpediatricautoimmuneneuropsychiatricdisorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome
  • (d) The office of the health insurance commissioner shall not allow the inclusion of the cost of the benefit coverage provided inthis sectionin the health insurance coverage rates proposed to be charged, or a rating formula proposed to be used, by any health insurance carrier to policy holders.
  • (e) 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 orbeforeJanuary1,2024,theofficeofthehealthinsurancecommissionershall reporttothe 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.
  • (f) This section shall sunset and be repealed effective December 31, 2024.
  • 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.
  • 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 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.
  • (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 assumeanyobligationforthecost ofcoverage forpediatricautoimmuneneuropsychiatricdisorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.
  • (d) The office of the health insurance commissioner shall not allow the inclusion of the cost of the benefit coverage provided inthis sectionin the health insurance coverage rates proposed to be charged, or a rating formula proposed to be used, by any health insurance carrier to policy holders.
  • (e) 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 orbeforeJanuary1,2024,theofficeofthehealthinsurancecommissionershall reporttothe 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.
  • (f) This section shall sunset and be repealed effective December 31, 2024.
  • 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.
  • 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.
  • (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 assumeanyobligationforthecost ofcoverageforpediatricautoimmuneneuropsychiatricdisorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.
  • (d) The office of the health insurance commissioner shall not allow the inclusion of the cost of the benefit coverage provided inthis sectionin the health insurance coverage rates proposed to be charged, or a rating formula proposed to be used, by any health insurance carrier to policy holders.
  • (e) 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 orbeforeJanuary1,2024,theofficeofthehealthinsurancecommissionershall reporttothe 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.
  • (f) This section shall sunset and be repealed effective December 31, 2024.
  • 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.
  • 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 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 assumeanyobligationforthecost ofcoverageforpediatricautoimmuneneuropsychiatricdisorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.
  • (d) The office of the health insurance commissioner shall not allow the inclusion of the cost of the benefit coverage provided inthis sectionin the health insurance coverage rates proposed to be charged, or a rating formula proposed to be used, by any health insurance carrier to policy holders.
  • (e) 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 orbeforeJanuary1,2024,theofficeofthehealthinsurancecommissionershall reporttothe 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.
  • (f) This section shall sunset and be repealed effective December 31, 2024.
  • SECTION 5. This act shall take effect upon passage.
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  • LC002393
  • LC002393/SUB A
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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. ======== LC002393 ========
  • This act would take effect upon passage. ======== LC002393/SUB A ========

Votes

NOTE: Electronic voting records are unofficial and may not be accurate. For an official vote tally, check the House or Senate Journal from the day of the vote.

Floor vote for PASSAGE

April 30, 2019 at 4:46pm
Yeas: 67 / Nays: 0 / Not voting: 8 / Recused: 0
Legislator Vote
Rep. Abney Y
Rep. Ackerman Y
Rep. Ajello Y
Rep. Almeida Y
Rep. Alzate Y
Rep. Amore Y
Rep. Azzinaro NV
Rep. Barros NV
Rep. Bennett Y
Rep. Blazejewski Y
Rep. Caldwell Y
Rep. Canario Y
Rep. Carson NV
Rep. Casey Y
Rep. Casimiro Y
Rep. Cassar Y
Rep. Chippendale Y
Rep. Cortvriend Y
Rep. Corvese Y
Rep. Costantino Y
Rep. Craven Y
Rep. Diaz Y
Rep. Donovan Y
Rep. Edwards Y
Rep. Fellela Y
Rep. Filippi Y
Rep. Fogarty NV
Rep. Handy Y
Rep. Hawkins Y
Rep. Hull Y
Rep. Jackson Y
Rep. Jacquard Y
Rep. Johnston Y
Rep. Kazarian Y
Rep. Kennedy Y
Rep. Kislak Y
Rep. Knight Y
Rep. Lima Y
Rep. Lombardi Y
Rep. Lyle Y
Rep. Maldonado Y
Rep. Marszalkowski Y
Rep. Mattiello Y
Rep. McEntee NV
Rep. McKiernan Y
Rep. McLaughlin Y
Rep. McNamara Y
Rep. Mendez Y
Rep. Messier Y
Rep. Millea Y
Rep. Morin Y
Rep. Nardone Y
Rep. Newberry Y
Rep. Noret Y
Rep. O'Brien Y
Rep. Phillips Y
Rep. Place Y
Rep. Price Y
Rep. Quattrocchi Y
Rep. Ranglin-Vassell Y
Rep. Roberts Y
Rep. Ruggiero Y
Rep. Serodio Y
Rep. Serpa NV
Rep. Shanley Y
Rep. Shekarchi Y
Rep. Slater Y
Rep. Solomon Y
Rep. Speakman Y
Rep. Tanzi Y
Rep. Tobon Y
Rep. Ucci NV
Rep. Vella-Wilkinson Y
Rep. Walsh Y
Rep. Williams NV