On Sep. 11, CAL LEG passed bill on coverage for PANDAS and PANS.
CAL LEG passed bill AB 2105 requiring insurance coverage for pediatric autoimmune neurophychiatric disorder associated with streptococcal infections (PANDAS).
Additionally, coverage for pediatric acute-onset neuropsychiatric syndrome (PANS).
Added new Section 1367.38 to CAL health and safety code, CAL LEG 2-2.2-5.
Also, added new Section 10123.38 to the CAL insurance Code, CAL INS 2-2-1-1.
Bill Provisions
Require coverage for prophylaxis, diagnosis, treatment that is prescribed or ordered by the treating physician and surgeon and is medically necessary of PANDAS, PANS.
Prohibit coverage for PANDAS and PANS from being subject to a copayment, coinsurance, deductible, other cost sharing greater than that applied to other benefits.
Cannot deny or delay coverage for PANDAS or PANS therapies because previously received treatment, received treatment for condition under different diagnostic name.
Coverage requirements will apply to health care service plan contract or health insurance policy that was issued, amended, or renewed on or after Jan. 1, 2025.
California Constitution requires State to reimburse local agencies and school districts for certain costs mandated; bill provides no reimbursement is required by this act.
Willful violation of provisions by health care service plan would be a crime.
Legislative History
On Feb. 2, 2024, bill introduced in Assembly; on May 21, 2024, bill passed Assembly.
On May 22, 2024, bill introduced into Senate; on Aug. 28, 2024, bill passed Senate.
On Aug. 29, 2024, bill amendments concurred; on Sep. 11, bill delivered to governor.
Effectiveness
No effective date specified; generally effective Jan. 1 after enactment, on Jan. 1, 2025.
Sep. 28, 2024 CAL LEG Governor Approved
On Sep. 28, 2024, CAL LEG reported governor approved AB-2105 as Chapter 822.
Regulators
CAL LEG
Entity Types
Ins
Reference
Ch 822, 9/28/2024; Bill, AB2105, 9/11/2024; Citation: CAL LEG 2-2.2-5; CAL INS 2-2-1-1;
