PANDAS, pediatric treatment

AN ACT Relating to expanding access to treatment of pediatric 1
autoimmune neuropsychiatric disorders associated with streptococcal 2
infections and pediatric acute-onset neuropsychiatric syndrome; and 3
adding a new section to chapter 48.43 RCW. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. A new section is added to chapter 48.43 6
RCW to read as follows: 7
(1) Except as provided in subsection (3) of this section, for 8
health plans other than health plans offered to public employees and 9
dependents under chapter 41.05 RCW issued or renewed on or after 10
January 1, 2027, health carriers shall provide initial coverage of 11
three monthly immunomodulatory courses of intravenous immunoglobulin 12
therapy for the treatment of pediatric autoimmune neuropsychiatric 13
disorders associated with streptococcal infections and pediatric 14
acute-onset neuropsychiatric syndrome, and subsequent courses as 15
deemed medically necessary by the treating provider, when the 16
following conditions are met: 17
(a) Clinically appropriate trials, which may be done 18
concurrently, if two less intensive treatments: 19
(i) Were not effective; 20
(ii) Were not tolerated; or 21
H-2443.2
HOUSE BILL 2196
State of Washington 69th Legislature 2026 Regular Session
By Representatives Simmons, Low, Leavitt, Paul, Nance, Duerr,
Stonier, Couture, Davis, Stuebe, and Lekanoff
Prefiled 12/24/25. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
p. 1 HB 2196
(iii) Did not result in sustained improvement in symptoms, as 1
measured by a lack of clinically meaningful improvement on a 2
validated instrument directed at the patient's primary symptom 3
complex; and 4
(b) The patient's treating provider recommends the treatment.5
(2) The health carrier may require that the patient be clinically 6
reevaluated at three-month intervals. 7
(3) Notwithstanding subsection (1) of this section, a health 8
carrier may not: 9
(a) Deny or delay the coverage required by this section because 10
the enrollee previously received treatment, including the same or 11
similar treatment, for pediatric autoimmune neuropsychiatric 12
disorders associated with streptococcal infections or pediatric 13
acute-onset neuropsychiatric syndrome or because the enrollee was 14
diagnosed with or received treatment for the condition under a 15
different diagnostic name, including autoimmune encephalopathy;16
(b) Limit coverage of immunomodulatory courses of intravenous 17
immunoglobulin therapy for the treatment of pediatric autoimmune 18
neuropsychiatric disorders associated with streptococcal infections 19
or pediatric acute-onset neuropsychiatric syndrome in a manner that 20
is inconsistent with the treatment guidelines developed by a 21
consortium convened for the purposes of researching, identifying, and 22
publishing best practice standards for diagnosis and treatment of 23
such syndrome or disorders that are accessible for medical 24
professionals and are based on evidence of positive patient outcomes;25
(c) Require a trial of therapies that treat only neuropsychiatric 26
symptoms before covering immunomodulatory courses of intravenous 27
immunoglobulin therapy for the treatment of pediatric autoimmune 28
neuropsychiatric disorders associated with streptococcal infections 29
or pediatric acute-onset neuropsychiatric syndrome;30
(d) Deny coverage for out-of-state treatment if the service is 31
not available within the state; or 32
(e) Deny coverage based on the age of the patient.33
--- END ---
p. 2 HB 2196