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Committee advances bill to list PANS/PANDAS among TennCare-covered conditions; legal change made permissive
Summary
House Bill 411, which would add PANS/PANDAS to a list of conditions TennCare would cover, advanced to full Insurance after sponsors amended the bill to make coverage permissive rather than mandatory.
House Bill 411, sponsored by Representative Lynn, advanced to the full Insurance Committee on a 7-0 vote after the sponsor attached an amendment and the committee discussed coverage language with TennCare and legal staff.
The original bill would have required TennCare and group health insurers to cover physician-prescribed treatments for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS and PANDAS). Sponsors said the aim is to reduce delayed diagnosis and ensure coverage for antibiotics, behavioral therapies and immunomodulating treatments when medically indicated.
TennCare requested and the sponsor accepted an amendment changing some statutory language from "shall require" to a permissive "may require." Legal staff clarified that the amendment means TennCare is permitted, but not strictly required, to adopt the specific new requirement: “The amendment does change it to May, so it is permissive. TennCare is permitted to require that, but they do not have to,” an attorney in the Office of Legal Services said.
Representative Lynn said TennCare officials told her the program already covers medically necessary treatment for these diagnoses even without a specific code in TennCare’s billing list. Committee members asked the sponsor to request a clarification from TennCare in the full committee about whether the permissive language could allow an insurer to deny coverage; Representative Lynn agreed to seek that confirmation.
The subcommittee voted 7-0 to send the amended House Bill 411 on to full Insurance.
