Tennessee 2025-2026 Regular Session

Tennessee Senate Bill SB1426 Compare Versions

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

Old	New	Differences
1	1
2	2	HOUSE BILL 411
3	3	By Lynn
4	4
5	5	SENATE BILL 1426
6	6	By Watson
7	7
8	8
9	9	SB1426
10	10	000450
11	11	- 1 -
12	12
13	13	AN ACT to amend Tennessee Code Annotated, Title 8;
14	14	Title 56 and Title 71, relative to pediatric medical
15	15	disorders.
16	16
17	17	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
18	18	SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
19	19	adding the following as a new section:
20	20	(a) For the purpose of this section, "managed care organization" or "MCO"
21	21	means a health maintenance organization, behavioral health organization, or managed
22	22	health insurance issuer that participates in the TennCare program.
23	23	(b) The division of TennCare shall require every group health insurance contract,
24	24	and every group hospital or medical expense insurance policy, plan, and group policy
25	25	delivered, issued for delivery, amended, or renewed in this state by an MCO on or after
26	26	January 1, 2026, to provide coverage for physician prescribed treatment, deemed
27	27	medically necessary pursuant to § 71-5-144, of pediatric autoimmune neuropsychiatric
28	28	disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset
29	29	neuropsychiatric syndrome (PANS). Such treatment must include antibiotics,
30	30	medication, behavioral therapies to manage neuropsychiatric symptoms,
31	31	immunomodulating medicines, plasma exchange, and intravenous immunoglobulin
32	32	therapy. Benefits provided under this section are not subject to a greater co-payment,
33	33	deductible, or coinsurance than another similar benefit provided by the MCO. Coverage
34	34	authorization must be provided in a timely manner consistent with department of
35	35	commerce and insurance rules for urgent treatments adopted pursuant to the Uniform
36	36	Administrative Procedures Act, compiled in title 4, chapter 5.
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38	38
39	39	- 2 - 000450
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41	41	(c) A group or individual policy of accident and health insurance or managed
42	42	care must not deny or delay coverage for medically necessary treatment under this
43	43	section solely because the recipient previously received treatment, including the same or
44	44	similar treatment, for PANDAS or PANS, or because the recipient has been diagnosed
45	45	with or received treatment for their condition under a different diagnostic name, such as
46	46	autoimmune encephalopathy. For the purposes of this section, coverage of PANDAS
47	47	and PANS must adhere to the treatment recommendations developed by a medical
48	48	professional consortium convened for the purposes of researching, identifying, and
49	49	publishing best practice standards for diagnosis and treatment of such disorders that are
50	50	accessible for medical professionals and are based on evidence of positive patient
51	51	outcomes. Coverage for a form of medically necessary treatment must not be limited
52	52	over the lifetime of a recipient or by the duration of a policy period. This section does not
53	53	prevent an MCO from requesting treatment notes and anticipated duration of treatment
54	54	and outcomes.
55	55	(d) For billing and diagnosis purposes, PANDAS and PANS must be coded as
56	56	autoimmune encephalitis until the American Medical Association and the centers for
57	57	medicare and medicaid services create and assign a specific code for PANDAS and
58	58	PANS. Thereafter, PANDAS and PANS may be coded as autoimmune encephalitis,
59	59	PANDAS, or PANS. If a new common name or code is utilized for PANDAS and PANS,
60	60	then this section applies to patients with conditions under that new common name or
61	61	code.
62	62	SECTION 2. This act takes effect upon becoming a law, the public welfare requiring it.