Read the full stored bill text
HB0292c -1- CSHB 292(L&C)
New Text Underlined [DELETED TEXT BRACKETED]
34-LS1209\H
CS FOR HOUSE BILL NO. 292(L&C)
IN THE LEGISLATURE OF THE STATE OF ALASKA
THIRTY-FOURTH LEGISLATURE - SECOND SESSION
BY THE HOUSE LABOR AND COMMERCE COMMITTEE
Offered: 4/24/26
Referred: Rules
Sponsor(s): REPRESENTATIVE COULOMBE
A BILL
FOR AN ACT ENTITLED
"An Act relating to insurance coverage for pediatric autoimmune neuropsychiatric 1
disorders; relating to medical assistance for pediatric autoimmune neuropsychiatric 2
disorders; and providing for an effective date." 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 4
* Section 1. AS 21.42 is amended by adding a new section to read: 5
Sec. 21.42.450. Coverage for pediatric autoimmune neuropsychiatric 6
disorders. (a) A health care insurer that offers, issues for delivery, delivers, or renews 7
in this state a health care insurance plan shall provide coverage for the prophylaxis, 8
diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders 9
associated with streptococcal infections and pediatric acute-onset neuropsychiatric 10
syndrome. Coverage must include the current standard of care for treatment of 11
pediatric autoimmune neuropsychiatric disorders associated with streptococcal 12
infections and pediatric acute-onset neuropsychiatric syndrome, treatment using 13
antimicrobials, medication, behavioral therapies to manage neuropsychiatric 14
34-LS1209\H
CSHB 292(L&C) -2- HB0292c
New Text Underlined [DELETED TEXT BRACKETED]
symptoms, immunomodulating medicines, plasma exchange, and intravenous 1
immunoglobulin therapy. 2
(b) An insurer may not 3
(1) deny or delay the coverage required under this section because the 4
enrollee previously received treatment, including the same or similar treatment, for the 5
conditions listed in this section or because the enrollee was diagnosed with or received 6
treatment for the condition under a different diagnostic name, including autoimmune 7
encephalopathy; 8
(2) limit coverage for immunomodulating therapy for the treatment of 9
pediatric autoimmune neuropsychiatric disorders associated with streptococcal 10
infections and pediatric acute-onset neuropsychiatric syndrome in a manner that is 11
inconsistent with the nationally recognized clinical practice treatment guidelines for 12
diagnosis and treatment of pediatric autoimmune neuropsychiatric disorders associated 13
with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome that 14
are accessible for medical professionals and are based on evidence of positive patient 15
outcomes; 16
(3) require a trial of therapies that treat only neuropsychiatric 17
symptoms before authorizing coverage of immunomodulating therapies for the 18
treatment of pediatric autoimmune neuropsychiatric disorders associated with 19
streptococcal infections and pediatric acute-onset neuropsychiatric syndrome; 20
(4) deny coverage for out-of-state treatment if the service is not 21
available in the state; or 22
(5) deny coverage based on age. 23
(c) Nothing in this section prevents an insurer from requesting treatment notes, 24
the anticipated duration of treatment, or expected outcomes, or from undertaking usual 25
and customary procedures, including prior authorization, to determine the 26
appropriateness of and medical necessity for treatment of pediatric autoimmune 27
neuropsychiatric disorders associated with streptococcal infections and pediatric 28
acute-onset neuropsychiatric syndrome, if the appropriate and medical necessity 29
determinations are made in the same manner as those determinations are made for the 30
treatment of any other illness, condition, or disorder covered by the health care 31
34-LS1209\H
HB0292c -3- CSHB 292(L&C)
New Text Underlined [DELETED TEXT BRACKETED]
insurance plan. 1
(d) Coverage under this section may not be more restrictive than or separate 2
from coverage provided for any other illness, condition, or disorder for purposes of 3
determining deductibles, benefit year or lifetime durational limits, benefit year or 4
lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance 5
factors, and benefit year maximum for deductibles and copayments and coinsurance 6
factors. 7
(e) In this section, 8
(1) "nationally recognized clinical practice treatment guidelines" 9
means evidence-based clinical practice guidelines developed by a nationally 10
recognized independent organization or medical professional society using a 11
transparent methodology and reporting structure with a conflict of interest policy and 12
for which the standards of care are informed by recommendations intended to 13
optimize patient care, systematic review of evidence, and assessment of the benefits 14
and risks of alternative care options; 15
(2) "pediatric acute-onset neuropsychiatric syndrome" means a 16
clinically defined disorder characterized by the sudden onset of obsessive-compulsive 17
symptoms or eating restrictions, associated with acute behavioral deterioration in at 18
least two designated domains with comorbid symptoms that may include anxiety, 19
sensory amplification or motor abnormalities, behavioral regression, deterioration in 20
school performance, mood disorder, urinary symptoms, or sleep disturbances; 21
(3) "pediatric autoimmune neuropsychiatric disorders associated with 22
streptococcal infection" means a subset of pediatric acute-onset neuropsychiatric 23
syndrome that is usually accompanied by similar comorbid symptoms found in 24
pediatric acute-onset neuropsychiatric syndrome and has the following five distinct 25
criteria for diagnosis: 26
(A) abrupt obsessive-compulsive symptoms or dramatic and 27
disabling tics; 28
(B) a relapsing-remitting, episodic symptom course; 29
(C) young age at onset; 30
(D) presence of neurological abnormalities; and 31
34-LS1209\H
CSHB 292(L&C) -4- HB0292c
New Text Underlined [DELETED TEXT BRACKETED]
(E) temporal association between symptom onset and group A 1
streptococcal infection. 2
* Sec. 2. AS 47.07.030(b) is amended to read: 3
(b) In addition to the mandatory services specified in (a) of this section and the 4
services provided under (d) of this section, the department may offer only the 5
following optional services: case management services for traumatic or acquired brain 6
injury; case management and nutrition services for pregnant women; personal care 7
services in a recipient's home; emergency hospital services; long-term care 8
noninstitutional services; medical supplies and equipment; advanced practice 9
registered nurse services; clinic services; rehabilitative services for children eligible 10
for services under AS 47.07.063, substance abusers, and emotionally disturbed or 11
chronically mentally ill adults; targeted case management services; inpatient 12
psychiatric facility services for individuals 65 years of age or older and individuals 13
under 21 years of age; psychologists' services; clinical social workers' services; marital 14
and family therapy services; professional counseling services; midwife services; 15
prescribed drugs; physical therapy; occupational therapy; chiropractic services; low-16
dose mammography screening, as defined in AS 21.42.375(e); treatment of pediatric 17
autoimmune neuropsychiatric disorders associated with streptococcal infections 18
and pediatric acute-onset neuropsychiatric syndrome as covered in AS 21.42.450; 19
hospice care; treatment of speech, hearing, and language disorders; adult dental and 20
dental hygiene services; prosthetic devices; [AND] eyeglasses; optometrists' services; 21
intermediate care facility services, including intermediate care facility services for 22
persons with intellectual and developmental disabilities; skilled nursing facility 23
services for individuals under 21 years of age; and reasonable transportation to and 24
from the point of medical care. 25
* Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 26
read: 27
MEDICAID STATE PLAN FEDERAL APPROVAL. To the extent necessary to 28
implement sec. 2 of this Act, the Department of Health shall amend and submit to the United 29
States Department of Health and Human Services for approval the state plan for medical 30
assistance coverage consistent with AS 47.07.030(b), as amended by sec. 2 of this Act. 31
34-LS1209\H
HB0292c -5- CSHB 292(L&C)
New Text Underlined [DELETED TEXT BRACKETED]
* Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 1
read: 2
CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 3
only if, on or before January 1, 2027, the United States Department of Health and Human 4
Services 5
(1) approves the amendment to the state plan for medical assistance coverage 6
under AS 47.07.030(b); or 7
(2) determines that approval of the amendment to the state plan for medical 8
assistance coverage under AS 47.07.030(b) is not necessary. 9
(b) The commissioner of health shall notify the revisor of statutes in writing within 30 10
days after the United States Department of Health and Human Services approves the 11
amendment to the state plan or determines that approval is not necessary under this section. 12
* Sec. 5. If sec. 2 of this Act takes effect, it takes effect on the day after the United States 13
Department of Health and Human Services approves the amendment submitted under sec. 3 14
of this Act or determines that approval of the amendment is not necessary. 15
* Sec. 6. Except as provided in sec. 5 of this Act, this Act takes effect January 1, 2027. 16