Tennessee 2025-2026 Regular Session

Tennessee House Bill HB0411 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2		-	SENATE BILL 1426
3		-	By Watson
	2	+	<BillNo> <Sponsor>
4	3
5	4		HOUSE BILL 411
6	5		By Lynn
7	6
8	7
9	8		HB0411
10	9		000450
11	10		- 1 -
12	11
13	12		AN ACT to amend Tennessee Code Annotated, Title 8;
14	13		Title 56 and Title 71, relative to pediatric medical
15	14		disorders.
16	15
17	16		BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
18	17		SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
19	18		adding the following as a new section:
20	19		(a) For the purpose of this section, "managed care organization" or "MCO"
21	20		means a health maintenance organization, behavioral health organization, or managed
22	21		health insurance issuer that participates in the TennCare program.
23	22		(b) The division of TennCare shall require every group health insurance contract,
24	23		and every group hospital or medical expense insurance policy, plan, and group policy
25	24		delivered, issued for delivery, amended, or renewed in this state by an MCO on or after
26	25		January 1, 2026, to provide coverage for physician prescribed treatment, deemed
27	26		medically necessary pursuant to § 71-5-144, of pediatric autoimmune neuropsychiatric
28	27		disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset
29	28		neuropsychiatric syndrome (PANS). Such treatment must include antibiotics,
30	29		medication, behavioral therapies to manage neuropsychiatric symptoms,
31	30		immunomodulating medicines, plasma exchange, and intravenous immunoglobulin
32	31		therapy. Benefits provided under this section are not subject to a greater co-payment,
33	32		deductible, or coinsurance than another similar benefit provided by the MCO. Coverage
34	33		authorization must be provided in a timely manner consistent with department of
35	34		commerce and insurance rules for urgent treatments adopted pursuant to the Uniform
36	35		Administrative Procedures Act, compiled in title 4, chapter 5.
37	36
38	37
39	38		- 2 - 000450
40	39
41	40		(c) A group or individual policy of accident and health insurance or managed
42	41		care must not deny or delay coverage for medically necessary treatment under this
43	42		section solely because the recipient previously received treatment, including the same or
44	43		similar treatment, for PANDAS or PANS, or because the recipient has been diagnosed
45	44		with or received treatment for their condition under a different diagnostic name, such as
46	45		autoimmune encephalopathy. For the purposes of this section, coverage of PANDAS
47	46		and PANS must adhere to the treatment recommendations developed by a medical
48	47		professional consortium convened for the purposes of researching, identifying, and
49	48		publishing best practice standards for diagnosis and treatment of such disorders that are
50	49		accessible for medical professionals and are based on evidence of positive patient
51	50		outcomes. Coverage for a form of medically necessary treatment must not be limited
52	51		over the lifetime of a recipient or by the duration of a policy period. This section does not
53	52		prevent an MCO from requesting treatment notes and anticipated duration of treatment
54	53		and outcomes.
55	54		(d) For billing and diagnosis purposes, PANDAS and PANS must be coded as
56	55		autoimmune encephalitis until the American Medical Association and the centers for
57	56		medicare and medicaid services create and assign a specific code for PANDAS and
58	57		PANS. Thereafter, PANDAS and PANS may be coded as autoimmune encephalitis,
59	58		PANDAS, or PANS. If a new common name or code is utilized for PANDAS and PANS,
60	59		then this section applies to patients with conditions under that new common name or
61	60		code.
62	61		SECTION 2. This act takes effect upon becoming a law, the public welfare requiring it.