HB 292 — An Act relating to insurance coverage for pediatric autoimmune neuropsychiatric disorders; and providing for an effective date.

34-LS1209\G34-LS1209\I CS FOR HOUSE BILL NO.

292(HSS)292 IN THE LEGISLATURE OF THE STATE OF ALASKA THIRTY-FOURTH LEGISLATURE - SECOND SESSION BY THEREPRESENTATIVES HOUSECOULOMBE, HEALTHCarrick ANDIntroduced: SOCIAL SERVICES COMMITTEE Referred:

Labor2/4/26 andReferred: Commerce, Finance Sponsor(s):

REPRESENTATIVESHealth COULOMBE,and CarrickSocial Services, Labor and Commerce, Finance A BILL FOR AN ACT ENTITLED "An Act relating to insurance coverage for pediatric autoimmune neuropsychiatric disorders;

relating to medical assistance for pediatric autoimmune neuropsychiatric disorders;

Coverage must include the current standard of care for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, treatment using antimicrobials, medication, behavioral therapies to manage neuropsychiatric HB0292b -1- CSHB 292(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1209\G symptoms, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy.

(b) An insurer may not (1) deny or delay the coverage required under this section because the HB0292a -1- HB 292 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1209\I enrollee previously received treatment, including the same or similar treatment, for the conditions listed in this section or because the enrollee was diagnosed with or received treatment for the condition under a different diagnostic name, including autoimmune encephalopathy;

(c) Nothing in this section prevents an insurer from requesting treatment notes, the anticipated duration of treatment, or expected outcomes, or from undertaking usual and customary procedures, including prior authorization, to determine the appropriateness of and medical necessity for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, if the appropriate and medical necessity determinations are made in the same manner as those determinations are made for the CSHB 292(HSS) -2- HB0292b New Text Underlined [DELETED TEXT BRACKETED] 34-LS1209\G treatment of any other illness, condition, or disorder covered by the health benefit plan.

(d) Coverage under this section may not be more restrictive than or separate from coverage provided for any other illness, condition, or disorder for purposes of HB 292 -2- HB0292a New Text Underlined [DELETED TEXT BRACKETED] 34-LS1209\I determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayments and coinsurance factors.

ASThis 47.07.030(b)Act istakes amendedeffect toJanuary read:1, 2027.

(b)HB0292a In-3- additionHB to292 theNew mandatoryText servicesUnderlined specified[DELETED inTEXT (a)BRACKETED] of this section and the services provided under (d) of this section, the department may offer only the following optional services:

case management services for traumatic or acquired brain HB0292b -3- CSHB 292(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1209\G injury;

case management and nutrition services for pregnant women;

personal care services in a recipient's home;

emergency hospital services;

long-term care noninstitutional services;

medical supplies and equipment;

advanced practice registered nurse services;

clinic services;

rehabilitative services for children eligible for services under AS 47.07.063, substance abusers, and emotionally disturbed or chronically mentally ill adults;

targeted case management services;

inpatient psychiatric facility services for individuals 65 years of age or older and individuals under 21 years of age;

psychologists' services;

clinical social workers' services;

marital and family therapy services;

professional counseling services;

midwife services;

prescribed drugs;

physical therapy;

occupational therapy;

chiropractic services;

low- dose mammography screening, as defined in AS 21.42.375(e);

treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome as covered in AS 21.42.450;

hospice care;

treatment of speech, hearing, and language disorders;

adult dental and dental hygiene services;

prosthetic devices;

[AND] eyeglasses;

optometrists' services;

intermediate care facility services, including intermediate care facility services for persons with intellectual and developmental disabilities;