RS 22:1028.6

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RS 22:1028.6

§1028.6. Required coverage for pediatric acute-onset neuropsychiatric syndrome (PANS); pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS); types of autoimmune encephalitis

A. Every health coverage plan renewed, delivered, or issued for delivery in this state shall provide coverage for PANS, PANDAS, and other types of AE, including but not limited to the use of intravenous immunoglobulin therapy. The coverage provided in this Section may be subject to annual deductibles, coinsurance, and copayment provisions as are consistent and established under the health coverage plan.

B.(1) In making determinations of coverage for PANDAS, PANS, and other types of AE, insurers may consider but not require strict adherence to other treatment options or recommendations developed by a medical professional consortium convened for the purposes of researching, identifying, and publishing best practice standards for diagnosis and treatment of these disorders, such as the PANDAS Physician Network. The treatment should be based on evidence of positive patient outcomes.

(2)A health coverage plan may limit intravenous immunoglobulin treatments to no more than three monthly courses of treatment, unless additional treatment is deemed medically necessary based on a clinical review using such guidelines.

C. For the purposes of this Section, the following terms apply:

(1)"Autoimmune encephalitis" or "AE" means any type of post infectious encephalitis where the immune system attacks the brain.

(2)"Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan and a self-insurance plan. "Health coverage plan" does not include the Office of Group Benefits programs, a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefits health insurance plans, or short-term policies that have a term of less than twelve months.

(3)"Pediatric acute-onset neuropsychiatric disorders associated with streptococcal infections" or "PANDAS" means a condition where there is evidence of an abnormal autoimmune or inflammatory response in the brain following streptococcal infections.

(4)"Pediatric acute-onset neuropsychiatric syndrome" or "PANS" means a condition defined by the sudden onset of obsessive-compulsive symptoms or severe eating restrictions, along with at least two other cognitive, behavioral, or neurological symptoms.

D. This Section shall be known and may be cited as the "The Gillian Guiffreda Act".

Acts 2025, No. 360, §2.