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SF 242

A bill for an act relating to health insurance coverage for specified pediatric autoimmune neuropsychiatric disorders and postinfectious autoimmune encephalopathy.

2025-2026 Regular Session Introduced by Annette Sweeney

SF 242 mandates health insurance coverage for children with PANS, PANDAS, and autoimmune encephalopathy, ensuring access to essential medical treatments.

Subcommittee recommends passage.
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Bill Summary · SF 242

Summary of SF 242: Health Insurance Coverage for Pediatric Autoimmune Disorders

Bill Number: SF 242
Introduced On: February 10, 2025
Current Status: Subcommittee recommends passage
Classification: Bill
Subjects: Health Insurance, Pediatrics, Autoimmune Disorders

Purpose and Intent

SF 242 aims to enhance health insurance coverage for specific pediatric autoimmune neuropsychiatric disorders, namely Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS), and postinfectious autoimmune encephalopathy. The bill seeks to ensure that children diagnosed with these conditions receive necessary medical treatment as deemed appropriate by healthcare professionals.

Key Provisions

  • Definitions:

    • PANS: Characterized by sudden onset of obsessive-compulsive symptoms or eating restrictions, accompanied by additional behavioral and sensory changes.
    • PANDAS: A subset of PANS specifically related to streptococcal infections.

  • Coverage Requirements:

    • Health carriers providing individual, group, or small group health insurance policies in the state must offer coverage for the diagnosis and treatment of PANS, PANDAS, and postinfectious autoimmune encephalopathy.
    • Coverage must be based on medical necessity as determined by a healthcare professional and must align with established medical standards and protocols.

  • Treatment Options:

    • The bill specifies that treatment may include, but is not limited to:
    • Antibiotics
    • Medications and behavioral therapies for neuropsychiatric symptoms
    • Plasma exchange

  • Regulatory Oversight:

    • The Commissioner of Insurance is tasked with adopting necessary rules to administer the provisions of this bill.

Affected Parties

  • Children and Adolescents: The primary beneficiaries of this bill are children diagnosed with PANS, PANDAS, and postinfectious autoimmune encephalopathy, who will gain access to essential medical treatments.
  • Health Carriers: Insurance companies will be required to adjust their policies to comply with the new coverage mandates.
  • Healthcare Providers: Medical professionals will play a crucial role in diagnosing and recommending treatment plans that align with the bill's requirements.

Procedural Aspects

  • Subcommittee Actions:
    • The bill was introduced and referred to the Commerce Committee on February 10, 2025.
    • A subcommittee meeting was held on February 13, 2025, with a recommendation for passage made on February 17, 2025.

Conclusion

SF 242 represents a significant step towards ensuring that children suffering from specific autoimmune neuropsychiatric disorders receive the necessary health insurance coverage for their treatment. By mandating coverage for these conditions, the bill aims to improve health outcomes for affected children and provide support for their families.

Compiled from official sources — confirm details with the bill’s official record.

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