Bill > HB2196

This bill mandates that health carriers, for group health plans issued or renewed on or after January 1, 2027, must cover the diagnosis and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, conditions that affect children's behavior and neurological function following a streptococcal infection. This coverage must include various treatments such as antibiotics, psychological and behavioral therapies, and specific medical interventions like plasma exchange and intravenous immunoglobulin therapy, which is a treatment involving the infusion of antibodies. The bill specifies that health carriers must cover three initial monthly courses of intravenous immunoglobulin therapy, and subsequent courses if deemed medically necessary by a doctor, provided that less intensive treatments were ineffective, not tolerated, or did not lead to sustained symptom improvement, and a treating provider recommends the therapy. Importantly, health carriers cannot deny or delay coverage based on prior treatment, a different diagnosis name, or age, nor can they impose treatment trial requirements that are inconsistent with established best practice guidelines or deny out-of-state treatment if the service isn't available within Washington state; however, this requirement does not apply to small group plans or plans for public employees.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=2196&Year=2025&Initiative=false