45-18-4.2. Required coverage for PANDAS or PANS health services.

As used in this Code section, the term:#

1. (1)

   “Nationally recognized clinical practice guidelines” means evidence based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Such guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.#

2. (2)

   “Pediatric acute-onset neuropsychiatric syndrome” or “PANS” means a class of acute-onset obsessive compulsive or tic disorders or other behavioral changes presenting in children and adolescents that are not otherwise explained by another known neurologic or medical disorder.#

3. (3)

   “Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections” or “PANDAS” means a condition in which a streptococcal infection in a child or adolescent causes the abrupt onset of clinically significant obsessions, compulsions, tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and remitting course of symptom severity.#

4. (4)

   “State health benefit plan” means the health insurance plan or plans established pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and public employees, dependents, and retirees.#

Beginning January 1, 2026, the state health benefit plan shall include coverage for healthcare services for PANDAS or PANS for an individual covered under such policy as provided in this Code section.#

Healthcare services for PANDAS or PANS for an individual covered under the state health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person’s disorder when such services are supported by nationally recognized clinical practice guidelines.#

The benefits in the state health benefit plan as provided for in this Code section shall be subject to the same deductibles, coinsurance, copayment provisions, and other limitations established for all covered benefits within such plan. Special deductibles, coinsurance, copayment, and other limitations that are not generally applicable to healthcare services covered by such plan shall not be imposed on coverage for healthcare services for PANDAS or PANS.#