CO| The Colorado Division of Insurance issued Bulletin No. B-4.154 to explain the impact of House Bill 24-1382, which concerns required coverage for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) in health benefit plans. Effective January 1, 2025, large group health plans must include coverage of prophylaxis, diagnosis, and treatment for PANS/PANDAS, while individual and small group plans must also provide this coverage as long as it does not exceed the state’s Essential Health Benefits (EHB) benchmark. Importantly, prescription medications, antibiotics, and behavioral health therapies are covered as part of EHB, but individual and small group plans are not required to cover treatments such as intravenous immunoglobulin (IVIG) and plasma exchange, since these exceed benchmark benefits.
Key Points:
- Large group health plans must cover prophylaxis, diagnosis, and treatment for PANS/PANDAS; individual and small group plans must cover these unless coverage exceeds EHB benchmarks.
- Treatments like IVIG and plasma exchange go beyond the state’s EHB benchmark and are not required for individual or small group plans, whereas antibiotics, medication therapies, and behavioral health therapies are included within required coverage.