Bill > HB0411

This bill, known as "Lucca's Law," requires TennCare (Tennessee's Medicaid program) and managed care organizations (MCOs) to provide coverage for treatment of two specific pediatric medical disorders: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Starting January 1, 2026, these organizations must cover physician-prescribed treatments deemed medically necessary, which can include antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. The bill ensures that these treatments cannot be denied or delayed solely based on previous treatment history or diagnostic naming, and it mandates that coverage be provided without additional financial burden to patients compared to other similar benefits. For billing purposes, these conditions will be coded as autoimmune encephalitis until specific medical coding systems create dedicated codes. The bill also allows for consideration of treatment recommendations from medical professional consortiums and requires timely coverage authorization consistent with existing insurance regulations, ultimately aiming to improve access to care for children with these complex autoimmune disorders.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB0411&ga=114