wa-law.org > bill > 2025-26 > HB 2196 > Original Bill
Except as provided in subsection (3) of this section, for health plans other than health plans offered to public employees and dependents under chapter 41.05 RCW issued or renewed on or after January 1, 2027, health carriers shall provide initial coverage of three monthly immunomodulatory courses of intravenous immunoglobulin therapy for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, and subsequent courses as deemed medically necessary by the treating provider, when the following conditions are met:
Clinically appropriate trials, which may be done concurrently, if two less intensive treatments:
Were not effective;
Were not tolerated; or
Did not result in sustained improvement in symptoms, as measured by a lack of clinically meaningful improvement on a validated instrument directed at the patient's primary symptom complex; and
The patient's treating provider recommends the treatment.
The health carrier may require that the patient be clinically reevaluated at three-month intervals.
Notwithstanding subsection (1) of this section, a health carrier may not:
Deny or delay the coverage required by this section because the enrollee previously received treatment, including the same or similar treatment, for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute-onset neuropsychiatric syndrome or because the enrollee was diagnosed with or received treatment for the condition under a different diagnostic name, including autoimmune encephalopathy;
Limit coverage of immunomodulatory courses of intravenous immunoglobulin therapy for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute-onset neuropsychiatric syndrome in a manner that is inconsistent with the treatment guidelines developed by a consortium convened for the purposes of researching, identifying, and publishing best practice standards for diagnosis and treatment of such syndrome or disorders that are accessible for medical professionals and are based on evidence of positive patient outcomes;
Require a trial of therapies that treat only neuropsychiatric symptoms before covering immunomodulatory courses of intravenous immunoglobulin therapy for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute-onset neuropsychiatric syndrome;
Deny coverage for out-of-state treatment if the service is not available within the state; or
Deny coverage based on the age of the patient.