Bill > SB1263

This bill establishes "Colton's Law", which requires health insurance carriers to provide coverage for medically necessary physician-prescribed treatments for two pediatric disorders: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). The coverage must include a range of treatments such as antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. The law mandates that these treatments cannot be subject to higher copayments, coinsurance, or deductibles than similar benefits, and health carriers cannot deny or delay coverage based on previous treatments or diagnostic history. The bill requires that coverage adhere to best practice standards developed by a healthcare professional consortium and ensures that treatment coverage is not limited by lifetime caps or policy periods. The law will apply to health benefit plans delivered, issued, or renewed in the state starting January 1, 2027, and does not apply to supplemental insurance policies. Additionally, the bill allows health carriers to request treatment notes and information about the anticipated treatment duration and outcomes.

Business and Industry

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=497