Bill > S0251

This bill mandates that health insurance plans provide coverage for the medically necessary diagnosis and treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), which are serious neurological and behavioral conditions in children. The coverage must include various treatments such as antibiotics, medications, mental health services, and more intensive therapies like plasma exchange and intravenous immunoglobulin therapy, and must align with established clinical practice guidelines. Importantly, insurance plans cannot impose higher out-of-pocket costs, such as deductibles or co-payments, for PANDAS and PANS treatment than for any other physical or mental condition. For billing purposes, these conditions can be coded as autoimmune encephalitis until specific codes are created by the American Medical Association and Centers for Medicare and Medicaid Services, after which those specific codes will be used. This legislation is set to take effect on January 1, 2027, with full implementation for all health insurance plans by January 1, 2028.

Budget and Finance

https://legislature.vermont.gov/bill/status/2026/S.251