Bill > SB1426

This bill, known as "Lucca's Law," requires TennCare (Tennessee's Medicaid program) and managed care organizations (MCOs) to provide comprehensive coverage for two specific pediatric medical disorders: PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome). The legislation mandates that group health insurance contracts must cover physician-prescribed treatments deemed medically necessary, including antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy, starting January 1, 2026. Importantly, the bill prohibits MCOs from denying or delaying coverage solely based on previous treatment history or diagnostic naming variations. For billing purposes, these disorders will be coded as autoimmune encephalitis until specific medical coding systems create distinct codes. The bill ensures that these treatments are subject to the same co-payment and deductible standards as other medical benefits and requires timely coverage authorization consistent with insurance regulations. The legislation aims to improve access to treatment for children suffering from these complex autoimmune neuropsychiatric conditions by ensuring comprehensive and consistent insurance coverage.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=SB1426&ga=114