2025 -- S 0473
========
LC002078
========
S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senators Lawson, Lauria, Murray, Sosnowski, Britto, DiMario, and
Valverde
Date Introduced: February 26, 2025
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-18-90 of the General Laws in Chapter 27-18 entitled "Accident 1
and Sickness Insurance Policies" is hereby amended to read as follows: 2
27-18-90. Mandatory coverage for treatment of pediatric autoimmune 3
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 4
neuropsychiatric syndrome. [Expires December 31, 2025.].Mandatory coverage for 5
treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 6
infections and pediatric acute onset neuropsychiatric syndrome. 7
(a) Every group health insurance contract, or every group hospital or medical expense 8
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 9
any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 10
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 11
pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 12
intravenous immunoglobin immunoglobulin therapy. 13
(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 14
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 15
be coded as autoimmune encephalitis until the American Medical Association and the Centers for 16
Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune 17
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 18
neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 19
LC002078 - Page 2 of 6
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 1
be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 2
with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 3
(c) The healthcare benefits outlined in this section apply only to services delivered within 4
the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 5
coverage for those benefits mandated by this section outside of the state of Rhode Island where it 6
can be established through a pre-authorization process that the required services are not available 7
in the state of Rhode Island from a provider in the health insurance carrier’s network. 8
(d) Each health insurance carrier shall collect and provide to the office of the health 9
insurance commissioner, in a form and frequency acceptable to the commissioner, information and 10
data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 11
or before January 1, 2025, the office of the health insurance commissioner shall report to the general 12
assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 13
section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 14
provided in this section produces a net savings to health insurance carriers and to policy holders. 15
(e) This section shall sunset and be repealed effective December 31, 2025. 16
SECTION 2. Section 27-19-82 of the General Laws in Chapter 27-19 entitled "Nonprofit 17
Hospital Service Corporations" is hereby amended to read as follows: 18
27-19-82. Mandatory coverage for treatment of pediatric autoimmune 19
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 20
neuropsychiatric syndrome. [Expires December 31, 2025.].Mandatory coverage for 21
treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 22
infections and pediatric acute onset neuropsychiatric syndrome. 23
(a) Every group health insurance contract, or every group hospital or medical expense 24
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 25
any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 26
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 27
pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 28
intravenous immunoglobin immunoglobulin therapy. 29
(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 30
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 31
be coded as autoimmune encephalitis until the American Medical Association and the Centers for 32
Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 33
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 34
LC002078 - Page 3 of 6
neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 1
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 2
be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 3
with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 4
(c) The healthcare benefits outlined in this section apply only to services delivered within 5
the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 6
coverage for those benefits mandated by this section outside of the state of Rhode Island where it 7
can be established through a pre-authorization process that the required services are not available 8
in the state of Rhode Island from a provider in the health insurance carrier’s network. 9
(d) Each health insurance carrier shall collect and provide to the office of the health 10
insurance commissioner, in a form and frequency acceptable to the commissioner, information and 11
data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 12
or before January 1, 2025, the office of the health insurance commissioner shall report to the general 13
assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 14
section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 15
provided in this section produces a net savings to health insurance carriers and to policyholders. 16
(e) This section shall sunset and be repealed effective December 31, 2025. 17
SECTION 3. Section 27-20-78 of the General Laws in Chapter 27-20 entitled "Nonprofit 18
Medical Service Corporations" is hereby amended to read as follows: 19
27-20-78. Mandatory coverage for treatment of pediatric autoimmune 20
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 21
neuropsychiatric syndrome. [Expires December 31, 2025.] Mandatory coverage for treatment 22
of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 23
and pediatric acute onset neuropsychiatric syndrome. 24
(a) Every group health insurance contract, or every group hospital or medical expense 25
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 26
any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 27
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 28
pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 29
intravenous immunoglobin immunoglobulin therapy. 30
(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 31
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 32
be coded as autoimmune encephalitis until the American Medical Association and the Centers for 33
Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 34
LC002078 - Page 4 of 6
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 1
neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 2
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 3
be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 4
with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 5
(c) The healthcare benefits outlined in this section apply only to services delivered within 6
the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 7
coverage for those benefits mandated by this section outside of the state of Rhode Island where it 8
can be established through a pre-authorization process that the required services are not available 9
in the state of Rhode Island from a provider in the health insurance carrier’s network. 10
(d) Each health insurance carrier shall collect and provide to the office of the health 11
insurance commissioner, in a form and frequency acceptable to the commissioner, information and 12
data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 13
or before January 1, 2025, the office of the health insurance commissioner shall report to the general 14
assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 15
section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 16
provided in this section produces a net savings to health insurance carriers and to policyholders. 17
(e) This section shall sunset and be repealed effective December 31, 2025. 18
SECTION 4. Section 27-41-95 of the General Laws in Chapter 27-41 entitled "Health 19
Maintenance Organizations" is hereby amended to read as follows: 20
27-41-95. Mandatory coverage for treatment of pediatric autoimmune 21
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 22
neuropsychiatric syndrome. [Expires December 31, 2025.].Mandatory coverage for 23
treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 24
infections and pediatric acute onset neuropsychiatric syndrome. 25
(a) Every group health insurance contract, or every group hospital or medical expense 26
insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 27
any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 28
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 29
pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 30
intravenous immunoglobin immunoglobulin therapy. 31
(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 32
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 33
be coded as autoimmune encephalitis until the American Medical Association and the Centers for 34
LC002078 - Page 5 of 6
Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 1
neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 2
neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 3
associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 4
be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 5
with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 6
(c) The healthcare benefits outlined in this section apply only to services delivered within 7
the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 8
coverage for those benefits mandated by this section outside of the state of Rhode Island where it 9
can be established through a pre-authorization process that the required services are not available 10
in the state of Rhode Island from a provider in the health insurance carrier’s network. 11
(d) Each health insurance carrier shall collect and provide to the office of the health 12
insurance commissioner, in a form and frequency acceptable to the commissioner, information and 13
data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 14
or before January 1, 2025, the office of the health insurance commissioner shall report to the general 15
assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 16
section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 17
provided in this section produces a net savings to health insurance carriers and to policyholders. 18
(e) This section shall sunset and be repealed effective December 31, 2025. 19
SECTION 5. This act shall take effect upon passage. 20
========
LC002078
========
LC002078 - Page 6 of 6
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would extend coverage for treatment of pediatric autoimmune neuropsychiatric 1
disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric 2
syndrome by removing the sunset date of December 31, 2025, and mandating such coverage. 3
This act would take effect upon passage. 4
========
LC002078
========