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Rhode Island House Bill H5625

Rhode Island 2025 Regular Session

Rhode Island House Bill H5625 Compare Versions

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99 S T A T E O F R H O D E I S L A N D
1010 IN GENERAL ASSEMBLY
1111 JANUARY SESSION, A.D. 2025
1212 ____________
1313
1414 A N A C T
1515 RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
1616 Introduced By: Representative Matthew S. Dawson
1717 Date Introduced: February 26, 2025
1818 Referred To: House Health & Human Services
1919
2020
2121 It is enacted by the General Assembly as follows:
2222 SECTION 1. Section 27-18-90 of the General Laws in Chapter 27-18 entitled "Accident 1
2323 and Sickness Insurance Policies" is hereby amended to read as follows: 2
2424 27-18-90. Mandatory coverage for treatment of pediatric autoimmune 3
2525 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 4
2626 neuropsychiatric syndrome. [Expires December 31, 2025.] Mandatory coverage for treatment 5
2727 of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 6
2828 and pediatric acute onset neuropsychiatric syndrome. 7
2929 (a) Every group health insurance contract, or every group hospital or medical expense 8
3030 insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 9
3131 any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 10
3232 pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 11
3333 pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 12
3434 intravenous immunoglobin therapy. 13
3535 (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 14
3636 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 15
3737 be coded as autoimmune encephalitis until the American Medical Association and the Centers for 16
3838 Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune 17
3939 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 18
4040 neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 19
4141
4242
4343 LC001991 - Page 2 of 6
4444 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 1
4545 be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 2
4646 with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 3
4747 (c) The healthcare benefits outlined in this section apply only to services delivered within 4
4848 the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 5
4949 coverage for those benefits mandated by this section outside of the state of Rhode Island where it 6
5050 can be established through a pre-authorization process that the required services are not available 7
5151 in the state of Rhode Island from a provider in the health insurance carrier’s network. 8
5252 (d) Each health insurance carrier shall collect and provide to the office of the health 9
5353 insurance commissioner, in a form and frequency acceptable to the commissioner, information and 10
5454 data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 11
5555 or before January 1, 2025, the office of the health insurance commissioner shall report to the general 12
5656 assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 13
5757 section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 14
5858 provided in this section produces a net savings to health insurance carriers and to policy holders. 15
5959 (e) This section shall sunset and be repealed effective December 31, 2025. 16
6060 SECTION 2. Section 27-19-82 of the General Laws in Chapter 27-19 entitled "Nonprofit 17
6161 Hospital Service Corporations" is hereby amended to read as follows: 18
6262 27-19-82. Mandatory coverage for treatment of pediatric autoimmune 19
6363 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 20
6464 neuropsychiatric syndrome. [Expires December 31, 2025.] Mandatory coverage for treatment 21
6565 of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 22
6666 and pediatric acute onset neuropsychiatric syndrome. 23
6767 (a) Every group health insurance contract, or every group hospital or medical expense 24
6868 insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 25
6969 any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 26
7070 pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 27
7171 pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 28
7272 intravenous immunoglobin therapy. 29
7373 (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 30
7474 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 31
7575 be coded as autoimmune encephalitis until the American Medical Association and the Centers for 32
7676 Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 33
7777 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 34
7878
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8181 neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 1
8282 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 2
8383 be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 3
8484 with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 4
8585 (c) The healthcare benefits outlined in this section apply only to services delivered within 5
8686 the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 6
8787 coverage for those benefits mandated by this section outside of the state of Rhode Island where it 7
8888 can be established through a pre-authorization process that the required services are not available 8
8989 in the state of Rhode Island from a provider in the health insurance carrier’s network. 9
9090 (d) Each health insurance carrier shall collect and provide to the office of the health 10
9191 insurance commissioner, in a form and frequency acceptable to the commissioner, information and 11
9292 data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 12
9393 or before January 1, 2025, the office of the health insurance commissioner shall report to the general 13
9494 assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 14
9595 section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 15
9696 provided in this section produces a net savings to health insurance carriers and to policyholders. 16
9797 (e) This section shall sunset and be repealed effective December 31, 2025. 17
9898 SECTION 3. Section 27-20-78 of the General Laws in Chapter 27-20 entitled "Nonprofit 18
9999 Medical Service Corporations" is hereby amended to read as follows: 19
100100 27-20-78. Mandatory coverage for treatment of pediatric autoimmune 20
101101 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 21
102102 neuropsychiatric syndrome. [Expires December 31, 2025.] Mandatory coverage for treatment 22
103103 of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 23
104104 and pediatric acute onset neuropsychiatric syndrome. 24
105105 (a) Every group health insurance contract, or every group hospital or medical expense 25
106106 insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 26
107107 any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 27
108108 pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 28
109109 pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 29
110110 intravenous immunoglobin therapy. 30
111111 (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 31
112112 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 32
113113 be coded as autoimmune encephalitis until the American Medical Association and the Centers for 33
114114 Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 34
115115
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118118 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 1
119119 neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 2
120120 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 3
121121 be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 4
122122 with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 5
123123 (c) The healthcare benefits outlined in this section apply only to services delivered within 6
124124 the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 7
125125 coverage for those benefits mandated by this section outside of the state of Rhode Island where it 8
126126 can be established through a pre-authorization process that the required services are not available 9
127127 in the state of Rhode Island from a provider in the health insurance carrier’s network. 10
128128 (d) Each health insurance carrier shall collect and provide to the office of the health 11
129129 insurance commissioner, in a form and frequency acceptable to the commissioner, information and 12
130130 data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 13
131131 or before January 1, 2025, the office of the health insurance commissioner shall report to the general 14
132132 assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 15
133133 section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 16
134134 provided in this section produces a net savings to health insurance carriers and to policyholders. 17
135135 (e) This section shall sunset and be repealed effective December 31, 2025. 18
136136 SECTION 4. Section 27-41-95 of the General Laws in Chapter 27-41 entitled "Health 19
137137 Maintenance Organizations" is hereby amended to read as follows: 20
138138 27-41-95. Mandatory coverage for treatment of pediatric autoimmune 21
139139 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 22
140140 neuropsychiatric syndrome. [Expires December 31, 2025.] Mandatory coverage for treatment 23
141141 of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 24
142142 and pediatric acute onset neuropsychiatric syndrome. 25
143143 (a) Every group health insurance contract, or every group hospital or medical expense 26
144144 insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 27
145145 any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 28
146146 pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 29
147147 pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 30
148148 intravenous immunoglobin therapy. 31
149149 (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 32
150150 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 33
151151 be coded as autoimmune encephalitis until the American Medical Association and the Centers for 34
152152
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154154 LC001991 - Page 5 of 6
155155 Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 1
156156 neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 2
157157 neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 3
158158 associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 4
159159 be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 5
160160 with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 6
161161 (c) The healthcare benefits outlined in this section apply only to services delivered within 7
162162 the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 8
163163 coverage for those benefits mandated by this section outside of the state of Rhode Island where it 9
164164 can be established through a pre-authorization process that the required services are not available 10
165165 in the state of Rhode Island from a provider in the health insurance carrier’s network. 11
166166 (d) Each health insurance carrier shall collect and provide to the office of the health 12
167167 insurance commissioner, in a form and frequency acceptable to the commissioner, information and 13
168168 data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 14
169169 or before January 1, 2025, the office of the health insurance commissioner shall report to the general 15
170170 assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 16
171171 section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 17
172172 provided in this section produces a net savings to health insurance carriers and to policyholders. 18
173173 (e) This section shall sunset and be repealed effective December 31, 2025. 19
174174 SECTION 5. This act shall take effect upon passage. 20
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181181 EXPLANATION
182182 BY THE LEGISLATIVE COUNCIL
183183 OF
184184 A N A C T
185185 RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
186186 ***
187187 This act would remove the sunset provision of all statutory law requiring coverage for the 1
188188 treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 2
189189 infections and pediatric acute onset neuropsychiatric syndrome, thus requiring insurance coverage 3
190190 to continue. 4
191191 This act would take effect upon passage. 5
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193193 LC001991
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