Senate Study Bill 1200 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON SCHULTZ) A BILL FOR An Act relating to health care benefits coverage for specified 1 pediatric autoimmune neuropsychiatric disorders. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1084XC (2) 89 ko/rn

S.F. _____ Section 1. NEW SECTION . 514C.36 Pediatric autoimmune 1 neuropsychiatric disorders associated with streptococcal 2 infections and pediatric acute-onset neuropsychiatric syndrome 3 —— coverage. 4 1. As used in this section, unless the context otherwise 5 requires: 6 a. “Covered person” means the same as defined in section 7 514J.102. 8 b. “Health care professional” means the same as defined in 9 section 514J.102. 10 c. “Health carrier” means the same as defined in section 11 514J.102. 12 d. “Pediatric acute-onset neuropsychiatric syndrome” or 13 “PANS” means a class of acute-onset obsessive compulsive or tic 14 disorders or other behavioral changes presenting in a child 15 that are not otherwise explained by another known neurologic or 16 medical disorder. 17 e. “Pediatric autoimmune neuropsychiatric disorders 18 associated with streptococcal infections” or “PANDAS” means 19 a condition in which a streptococcal infection in a child 20 causes the abrupt onset of clinically significant obsessions, 21 compulsions, tics, or other neuropsychiatric symptoms or 22 behavioral changes, or a relapsing and remitting course of 23 symptom severity. 24 2. Notwithstanding the uniformity of treatment requirements 25 of section 514C.6, a health carrier that offers individual, 26 group, or small group contracts, policies, or plans in this 27 state that provide for third-party payment or prepayment 28 of health or medical expenses shall offer coverage for the 29 diagnosis and treatment of PANS and PANDAS as recommended by 30 a health care professional for a covered person who is age 31 eighteen or younger. 32 3. a. This section shall apply to the following classes 33 of third-party payment provider contracts, policies, or plans 34 delivered, issued for delivery, continued, or renewed in this 35 -1- LSB 1084XC (2) 89 ko/rn 1/ 3

S.F. _____ state on or after January 1, 2022: 1 (1) Individual or group accident and sickness insurance 2 providing coverage on an expense-incurred basis. 3 (2) An individual or group hospital or medical service 4 contract issued pursuant to chapter 509, 514, or 514A. 5 (3) An individual or group health maintenance organization 6 contract regulated under chapter 514B. 7 (4) A plan established for public employees pursuant to 8 chapter 509A. 9 b. This section shall not apply to accident-only, 10 specified disease, short-term hospital or medical, hospital 11 confinement indemnity, credit, dental, vision, Medicare 12 supplement, long-term care, basic hospital and medical-surgical 13 expense coverage as defined by the commissioner, disability 14 income insurance coverage, coverage issued as a supplement 15 to liability insurance, workers’ compensation or similar 16 insurance, or automobile medical payment insurance. 17 4. The commissioner of insurance shall adopt rules pursuant 18 to chapter 17A as necessary to administer this section. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to health care coverage benefits for 23 pediatric acute-onset neuropsychiatric syndrome (PANS) and 24 pediatric autoimmune neuropsychiatric disorders associated with 25 streptococcal infections (PANDAS). 26 The bill defines “PANS” as a class of acute-onset obsessive 27 compulsive or tic disorders or other behavioral changes 28 presenting in a child that are not otherwise explained by 29 another known neurologic or medical disorder. “PANDAS” is 30 defined as a condition in which a streptococcal infection in 31 a child causes the abrupt onset of clinically significant 32 obsessions, compulsions, tics, or other neuropsychiatric 33 symptoms or behavioral changes, or a relapsing and remitting 34 course of symptom severity. 35 -2- LSB 1084XC (2) 89 ko/rn 2/ 3

S.F. _____ The bill requires a health carrier that offers individual, 1 group, or small group contracts, policies, or plans in this 2 state that provide for third-party payment or prepayment of 3 health or medical expenses to offer coverage for the diagnosis 4 and treatment of PANS and PANDAS as recommended by a health 5 care professional for a covered person who is age 18 or 6 younger. 7 The bill applies to third-party payment provider contracts, 8 policies, or plans delivered, issued for delivery, continued, 9 or renewed in this state on or after January 1, 2022, by the 10 third-party payment providers enumerated in the bill. 11 The bill specifies the types of specialized health-related 12 insurance which are not subject to the bill’s coverage 13 requirements. 14 The commissioner of insurance is required to adopt rules to 15 administer the bill. 16 -3- LSB 1084XC (2) 89 ko/rn 3/ 3