Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0473 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- S 0473
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7	7	LC002078
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Senators Lawson, Lauria, Murray, Sosnowski, Britto, DiMario, and
17	17	Valverde
18	18	Date Introduced: February 26, 2025
19	19	Referred To: Senate Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 27-18-90 of the General Laws in Chapter 27-18 entitled "Accident 1
24	24	and Sickness Insurance Policies" is hereby amended to read as follows: 2
25	25	27-18-90. Mandatory coverage for treatment of pediatric autoimmune 3
26	26	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 4
27	27	neuropsychiatric syndrome. [Expires December 31, 2025.].Mandatory coverage for 5
28	28	treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 6
29	29	infections and pediatric acute onset neuropsychiatric syndrome. 7
30	30	(a) Every group health insurance contract, or every group hospital or medical expense 8
31	31	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 9
32	32	any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 10
33	33	pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 11
34	34	pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 12
35	35	intravenous immunoglobin immunoglobulin therapy. 13
36	36	(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 14
37	37	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 15
38	38	be coded as autoimmune encephalitis until the American Medical Association and the Centers for 16
39	39	Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune 17
40	40	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 18
41	41	neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 19
42	42
43	43
44	44	LC002078 - Page 2 of 6
45	45	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 1
46	46	be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 2
47	47	with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 3
48	48	(c) The healthcare benefits outlined in this section apply only to services delivered within 4
49	49	the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 5
50	50	coverage for those benefits mandated by this section outside of the state of Rhode Island where it 6
51	51	can be established through a pre-authorization process that the required services are not available 7
52	52	in the state of Rhode Island from a provider in the health insurance carrier’s network. 8
53	53	(d) Each health insurance carrier shall collect and provide to the office of the health 9
54	54	insurance commissioner, in a form and frequency acceptable to the commissioner, information and 10
55	55	data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 11
56	56	or before January 1, 2025, the office of the health insurance commissioner shall report to the general 12
57	57	assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 13
58	58	section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 14
59	59	provided in this section produces a net savings to health insurance carriers and to policy holders. 15
60	60	(e) This section shall sunset and be repealed effective December 31, 2025. 16
61	61	SECTION 2. Section 27-19-82 of the General Laws in Chapter 27-19 entitled "Nonprofit 17
62	62	Hospital Service Corporations" is hereby amended to read as follows: 18
63	63	27-19-82. Mandatory coverage for treatment of pediatric autoimmune 19
64	64	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 20
65	65	neuropsychiatric syndrome. [Expires December 31, 2025.].Mandatory coverage for 21
66	66	treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 22
67	67	infections and pediatric acute onset neuropsychiatric syndrome. 23
68	68	(a) Every group health insurance contract, or every group hospital or medical expense 24
69	69	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 25
70	70	any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 26
71	71	pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 27
72	72	pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 28
73	73	intravenous immunoglobin immunoglobulin therapy. 29
74	74	(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 30
75	75	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 31
76	76	be coded as autoimmune encephalitis until the American Medical Association and the Centers for 32
77	77	Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 33
78	78	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 34
79	79
80	80
81	81	LC002078 - Page 3 of 6
82	82	neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 1
83	83	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 2
84	84	be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 3
85	85	with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 4
86	86	(c) The healthcare benefits outlined in this section apply only to services delivered within 5
87	87	the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 6
88	88	coverage for those benefits mandated by this section outside of the state of Rhode Island where it 7
89	89	can be established through a pre-authorization process that the required services are not available 8
90	90	in the state of Rhode Island from a provider in the health insurance carrier’s network. 9
91	91	(d) Each health insurance carrier shall collect and provide to the office of the health 10
92	92	insurance commissioner, in a form and frequency acceptable to the commissioner, information and 11
93	93	data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 12
94	94	or before January 1, 2025, the office of the health insurance commissioner shall report to the general 13
95	95	assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 14
96	96	section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 15
97	97	provided in this section produces a net savings to health insurance carriers and to policyholders. 16
98	98	(e) This section shall sunset and be repealed effective December 31, 2025. 17
99	99	SECTION 3. Section 27-20-78 of the General Laws in Chapter 27-20 entitled "Nonprofit 18
100	100	Medical Service Corporations" is hereby amended to read as follows: 19
101	101	27-20-78. Mandatory coverage for treatment of pediatric autoimmune 20
102	102	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 21
103	103	neuropsychiatric syndrome. [Expires December 31, 2025.] Mandatory coverage for treatment 22
104	104	of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 23
105	105	and pediatric acute onset neuropsychiatric syndrome. 24
106	106	(a) Every group health insurance contract, or every group hospital or medical expense 25
107	107	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 26
108	108	any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 27
109	109	pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 28
110	110	pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 29
111	111	intravenous immunoglobin immunoglobulin therapy. 30
112	112	(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 31
113	113	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 32
114	114	be coded as autoimmune encephalitis until the American Medical Association and the Centers for 33
115	115	Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 34
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117	117
118	118	LC002078 - Page 4 of 6
119	119	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 1
120	120	neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 2
121	121	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 3
122	122	be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 4
123	123	with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 5
124	124	(c) The healthcare benefits outlined in this section apply only to services delivered within 6
125	125	the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 7
126	126	coverage for those benefits mandated by this section outside of the state of Rhode Island where it 8
127	127	can be established through a pre-authorization process that the required services are not available 9
128	128	in the state of Rhode Island from a provider in the health insurance carrier’s network. 10
129	129	(d) Each health insurance carrier shall collect and provide to the office of the health 11
130	130	insurance commissioner, in a form and frequency acceptable to the commissioner, information and 12
131	131	data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 13
132	132	or before January 1, 2025, the office of the health insurance commissioner shall report to the general 14
133	133	assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 15
134	134	section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 16
135	135	provided in this section produces a net savings to health insurance carriers and to policyholders. 17
136	136	(e) This section shall sunset and be repealed effective December 31, 2025. 18
137	137	SECTION 4. Section 27-41-95 of the General Laws in Chapter 27-41 entitled "Health 19
138	138	Maintenance Organizations" is hereby amended to read as follows: 20
139	139	27-41-95. Mandatory coverage for treatment of pediatric autoimmune 21
140	140	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 22
141	141	neuropsychiatric syndrome. [Expires December 31, 2025.].Mandatory coverage for 23
142	142	treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal 24
143	143	infections and pediatric acute onset neuropsychiatric syndrome. 25
144	144	(a) Every group health insurance contract, or every group hospital or medical expense 26
145	145	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 27
146	146	any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of 28
147	147	pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and 29
148	148	pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of 30
149	149	intravenous immunoglobin immunoglobulin therapy. 31
150	150	(b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders 32
151	151	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall 33
152	152	be coded as autoimmune encephalitis until the American Medical Association and the Centers for 34
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154	154
155	155	LC002078 - Page 5 of 6
156	156	Medicare & Medicaid Services create and assign a specific code for pediatric autoimmune 1
157	157	neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset 2
158	158	neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders 3
159	159	associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may 4
160	160	be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated 5
161	161	with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. 6
162	162	(c) The healthcare benefits outlined in this section apply only to services delivered within 7
163	163	the state of Rhode Island; provided, that all health insurance carriers shall be required to provide 8
164	164	coverage for those benefits mandated by this section outside of the state of Rhode Island where it 9
165	165	can be established through a pre-authorization process that the required services are not available 10
166	166	in the state of Rhode Island from a provider in the health insurance carrier’s network. 11
167	167	(d) Each health insurance carrier shall collect and provide to the office of the health 12
168	168	insurance commissioner, in a form and frequency acceptable to the commissioner, information and 13
169	169	data reflecting the costs and the savings of adding the benefit coverage provided in this section. On 14
170	170	or before January 1, 2025, the office of the health insurance commissioner shall report to the general 15
171	171	assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this 16
172	172	section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage 17
173	173	provided in this section produces a net savings to health insurance carriers and to policyholders. 18
174	174	(e) This section shall sunset and be repealed effective December 31, 2025. 19
175	175	SECTION 5. This act shall take effect upon passage. 20
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182	182	EXPLANATION
183	183	BY THE LEGISLATIVE COUNCIL
184	184	OF
185	185	A N A C T
186	186	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
187	187	***
188	188	This act would extend coverage for treatment of pediatric autoimmune neuropsychiatric 1
189	189	disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric 2
190	190	syndrome by removing the sunset date of December 31, 2025, and mandating such coverage. 3
191	191	This act would take effect upon passage. 4
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