What's happening
This bill requires health insurance policies in New York to cover medically necessary treatment for pediatric acute-onset neuropsychiatric syndrome.
Why it matters
Expands access to necessary care. By mandating insurance coverage for pediatric acute-onset neuropsychiatric syndrome (PANS), this bill ensures that children diagnosed with this condition can access treatments that their doctors deem medically necessary, potentially improving outcomes and reducing the burden on families.
Limits insurer discretion. The bill specifically requires coverage when a physician certifies the treatment’s medical necessity, reducing the ability of insurers to deny claims based on their own internal criteria or to classify care as experimental or not covered.
Addresses a gap in current law. Previously, insurance policies may have excluded or limited coverage for rare or emerging conditions like PANS. This amendment fills a gap, responding to advocacy from affected families and the medical community for more reliable coverage.
Creates uniform standards. By referencing the definition of PANS from public health law, the bill standardizes eligibility and coverage requirements across all insurers, offering clarity for providers, payers, and families about what is covered and under what circumstances.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Insure Kids' Rare Syndrome
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover Kids' Neuropsychiatric Care
In Assembly Committee · Insurance · Sponsor Billy Jones
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1994
2019-2020 Regular Sessions
IN SENATE
January 18, 2019
Introduced by Sen. LITTLE -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring certain health insurance policies to cover costs for pediatric acute-onset neuropsychiatric syndrome
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 35 to read as follows:
(35)(A) Every health plan, and health insurance issuer offering health insurance coverage in connection with a group health plan, shall provide coverage for a participant or beneficiary who has pediatric acute-onset neuropsychiatric syndrome if the attending physician of the participant or beneficiary certifies in writing the medical necessity of that proposed course of rehabilitative treatment.
(B) As used in this paragraph, the term "pediatric acute-onset neuropsychiatric syndrome" shall have the same meaning as such term is used in paragraph (n) of subdivision one of section two hundred seven of the public health law.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22) (A) Every health plan, and health insurance issuer offering health insurance coverage in connection with a group health plan, shall provide coverage for a participant or beneficiary who has pediatric acute-onset neuropsychiatric syndrome if the attending physician of the participant or beneficiary certifies in writing the medical necessity of that proposed course of rehabilitative treatment.
(B) As used in this paragraph, the term "pediatric acute-onset neuropsychiatric syndrome" shall have the same meaning as such term is used in paragraph (n) of subdivision one of section two hundred seven of the public health law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02904-01-9
S. 1994 2
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss)(1) Every health plan, and health insurance issuer offering health insurance coverage in connection with a group health plan, shall provide coverage for a participant or beneficiary who has pediatric acute-onset neuropsychiatric syndrome if the attending physician of the participant or beneficiary certifies in writing the medical necessity of that proposed course of rehabilitative treatment.
(2) As used in this paragraph, the term "pediatric acute-onset neuropsychiatric syndrome" shall have the same meaning as such term is used in paragraph (n) of subdivision one of section two hundred seven of the public health law.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to requiring certain health insurance policies to cover costs for pediatric acute-onset neuropsychiatric syndrome
Purpose
This bill will require certain health insurance policies to cover costs associated with pediatric acute-onset neuropsychiatric syndrome.
Summary of provisions
Section 1: Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 34
Section 2: Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22
Section 3: Section 4303 of the insurance law is amended by adding a new subsection (oo)
Justification
Pediatric acute-onset neuropsychiatric syndrome (PANS) is a misdirected immune response, often with an encephalitic onset, which negatively affects neurologic functioning, resulting in a rapid, acute onset of OCD, restricted food intake or tics along with other neuropsychiatric conditions.
Treating PANS must be carried out thoroughly to yield positive results. Symptoms often begin to improve within one week of antibiotic treatment. However, further interventions are often required to fully heal the underlying causes and alleviate all the symptoms. If treated promptly and thoroughly, symptoms can remit completely. If left untreated and symptoms persist, permanent neurological injury can occur.
Currently insurance providers do not cover costs associated with pedia- tric acute-onset neuropsychiatric syndrome which can cause a huge finan- cial burden for families living with this diagnosis. This bill would help to relieve this burden and give these families a resource to treat the syndrome.
Legislative history
2017-18: S.7256/A.8839: Referred Insurance; Referred Insurance
Fiscal implications
To be determined.
Effective date
This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such effective date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.