Committee adopts amendment adding 'standard-of-care' language to PANS/PANDAS insurance bill; HB292 cleared from committee

Lawmakers on the House Health and Social Services Committee on Tuesday amended and moved forward House Bill 292, a measure requiring insurers to cover specified treatments for PANS/PANDAS, after a sustained debate about whether the statute should refer to a prescriptive list of therapies or to the "current standard of care."

Representative Gray moved amendment 3 to add a clause that coverage "must also include the current standard of care," arguing it would keep the statute durable as clinical practice evolves. Heather Carpenter, director of the Division of Insurance, said the division relies on insurer clinical guidelines and independent peer review during appeals and had no structural objection to the amendment.

Proponents and stakeholders noted several ways states handle similar language: some cite specialist consortium guidance or clinical references such as UpToDate; others prefer a list plus a catchall. Sarah Lemley of the Northwest PANS/PANDAS Network told the committee many providers consult the PANS consortium and UpToDate, and that an inclusive standard helps new therapies reach patients.

Representative Ruffridge expressed concern that a broad "standard of care" phrase could require coverage of costly future treatments and stressed the role of prior authorization and cost controls. After debate and a roll call, the committee adopted amendment 3 by a recorded vote of 5 yeas and 2 nays. Representative Gray then moved HB292, as amended, from committee with individual recommendations and an indeterminate fiscal note; with no objection, the bill passed out of committee.

The committee record shows the sponsor supported the change with amendments and will proceed with committee report and next steps. The amended bill will continue through the legislative process with the committee’s recommendation.