An act relating to health insurance coverage for diagnosis and treatment of certain pediatric neuropsychiatric conditions

This bill (S.251) requires health insurance plans in Vermont to cover the medically necessary diagnosis and treatment of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) for children. It mandates coverage for specific treatments like antibiotics, mental health services, and immune-related therapies, without higher cost-sharing than for other conditions. Insurers must follow current clinical guidelines for these treatments and temporarily use "autoimmune encephalitis" as a billing code until specific PANDAS/PANS codes are created. The law takes effect January 1, 2027, applying to all new or renewed health insurance plans after that date.