House approves bill expanding insurance coverage for PANS/PANDAS treatments after debate over costs and scope

The House voted to pass Engrossed Substitute House Bill 21-96, legislation described by backers as expanding access to medical treatments for children diagnosed with PANS and PANDAS. The measure passed by recorded roll call, 83 yays, 13 nays, 2 excused.

Representative Michelle Simmons (23rd District), speaking in support, said the bill responds to families who cannot access treatment and recounted constituent stories. "This disorder . . . has caused a lot of children in our state to end up in psychiatric units when they don't have a psychiatric disorder," Simmons said, and added that some families pay for expensive treatments including IVIG.

Floor debate focused on the scope of coverage and fiscal impact. Representative Schmick urged a no vote on parts of the bill that he said would drive insurance premiums up, noting that "the average cost for one [IVIG] treatment is around $6,000" and that multiple treatments may be required. Lawmakers adopted amendment 18-83, which narrows a coverage requirement to large-group plans only (adopted 54–36–2). Amendment 19-43, which would have included the state's PEBB and SEBB insurance programs within the requirement, failed to pass amid concerns about the state's fiscal exposure.

Supporters argued the bill provides necessary access for a rare but debilitating condition and cited cases where families incurred severe financial hardship to obtain treatment. Critics argued that exempting the state and narrowing markets undercuts the policy's intended reach and could shift costs onto private market premiums.

With the recorded vote complete, the bill was declared passed by a constitutional majority and will proceed through the remaining legislative steps required for enactment.