Mandating health insurance coverage treatment of pediatric patients diagnoced with PANDAS or PANS

HB 4197 requires all health insurance plans in West Virginia to cover medically necessary treatments for pediatric patients diagnosed with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) or PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). The bill mandates coverage for specific treatments including antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and IVIG therapy, without higher copays or deductibles than other covered services. Insurers cannot deny or delay coverage based on prior treatment history, alternative diagnoses (like autoimmune encephalopathy), or previous coverage for similar conditions. This applies to all group health insurance plans and managed care organizations issued or renewed in West Virginia on or after January 1, 2027.