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Bill Summary · HB 831

Summary of HB 831 (Ohio, 136th General Assembly)

Purpose and intent

  • The bill seeks to require health plan issuers and Ohio’s Medicaid program to cover screening, diagnosis, and treatment for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).
  • It designates a PANDAS/PANS Awareness Day on October 9 each year.
  • It lays out explicit coverage requirements and protections from cost-sharing and administrative hurdles.

Key provisions

  • Designation of awareness day

    • Sec. 5.22108: October 9 is designated as “PANDAS and PANS Awareness Day.”

  • Definitions and scope (Sec. 3902.50)

    • Establishes consistent definitions for terms used in coverage provisions (e.g., covered, health plan issuer, prior authorization, step therapy, out-of-network care, etc.) to apply across related sections.

  • Health plan coverage for PANDAS/PANS (Sec. 3902.65)

    • Applies to health plans issued, delivered, or renewed on/after the act’s effective date.
    • Requires coverage for screening, diagnosis, and treatment of PANDAS and PANS.
    • Prohibits applying more restrictive cost-sharing to this coverage than to other medical/surgical benefits.
    • Minimum required benefits:
    • Comprehensive diagnostic evaluation and related services (laboratory, radiology, psychiatric/behavioral services).
    • Immunomodulatory therapies, including:
      • Immunoglobulin therapy (high and low dose) and related medications, administration, and monitoring
      • Corticosteroids
      • Plasmapheresis
      • Rituximab or similar products
    • Antimicrobial treatment (antibiotics and antivirals)
    • Therapeutic care from licensed/certified therapists (speech, occupational, physical, etc.)
    • Protections against administrative barriers:
    • No step therapy protocol or prior authorization required for this coverage.
    • Coverage not contingent on symptom severity thresholds or specific immunodeficiency status.
    • Federal/subsidy caveat:
    • If Ohio is required to defray costs under PPACA or related federal guidance, the state’s cost obligation for this coverage is inoperative, with limited alignment to 42 U.S.C. 1396a.

  • Medicaid coverage for PANDAS/PANS (Sec. 5164.094)

    • Mirrors the above coverage obligations for the Medicaid program.
    • Requires screening, diagnosis, and treatment coverage for PANDAS/PANS.
    • Prohibits cost-sharing for this coverage that is more burdensome than typical medical/surgical benefits.
    • Minimum required benefits and protections align with Sec. 3902.65:
    • Comprehensive diagnostic evaluation and related services
    • Immunomodulatory therapies (immunoglobulin therapy, corticosteroids, plasmapheresis, rituximab or similar)
    • Antimicrobial treatment (antibiotics/antivirals)
    • Therapeutic services by licensed therapists
    • No step therapy or prior authorization for this coverage.
    • Federal subsidy caveat mirrors Sec. 3902.65.

Who would be affected

  • Health plan issuers operating in Ohio, including private commercial plans and any group/individual plans subject to state oversight.
  • Medicaid program in Ohio, which would be required to cover PANDAS/PANS-related services and therapies.
  • Beneficiaries: children and adolescents who require evaluation and treatment for PANDAS and PANS, as well as their families, who would experience standardized coverage and removal of some administrative barriers.

Procedural and timeline aspects

  • Introduced: April 21, 2026.
  • Referred to committee: May 13, 2026.
  • Effective date: Not specified in the text provided; the bill states that the new coverage requirements apply to health plans issued, delivered, or renewed on or after the effective date of the section. The exact effective date would be determined during floor consideration or through final legislative action.

Additional notes

  • The bill repeals an existing section (Sec. 3902.50) and reorganizes definitions and coverage rules to accommodate the new PANDAS/PANS requirements.
  • It includes protections against federal cost-shares or cost defrayals affecting the state’s obligations, aligning with PPACA-related cost issues.

Overall impact

HB 831 aims to ensure that affected Ohio children have access to comprehensive, barrier-free coverage for PANDAS and PANS, including diagnostic workups, immunomodulatory therapies, antimicrobial treatments, and rehabilitative services, with minimized administrative hurdles and no preferential cost-sharing compared to other medical benefits.

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

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