Senate advances bill to require coverage for PANS/PANDAS treatments after committee changes

Senator George Dungan introduced LB 7‑62 to require insurance coverage for a range of treatments for pediatric acute‑onset neuropsychiatric syndrome (PANS) and the streptococcal subset PANDAS, including antibiotics, steroids and, in some cases, intravenous immunoglobulin (IVIG). Dungan said the number of affected children is small and that many families have faced denials for prescribed treatments.

The Banking, Commerce and Insurance Committee offered AM 23‑80, a white‑copy amendment that (1) codifies definitions for PANS/PANDAS, (2) requires coverage beginning Jan. 1, 2027, and (3) narrows the scope by specifying that covered treatments must be recommended by a patient's licensed physician. Committee chair Senator Jacobson explained the change was meant to clarify who may recommend treatments and to reduce ambiguity.

Floor debate included emotional testimony described by senators in the gallery and technical discussion of the fiscal implications and the federal defrayal process under the Affordable Care Act. Committee and several floor speakers argued early treatment can avoid larger costs (including institutionalization) and that many insurers already voluntarily cover some treatments; others cautioned that mandated coverage can create premiums increases and potential defrayal claims against the state. The Department of Insurance supplied an estimated defrayal scenario cited in debate (about $947,000 annually in one actuarial estimate), while state plan impacts were cited at roughly $86,000 per year in one estimate; university plan costs were discussed as indeterminate.

The committee amendment AM 23‑80 was adopted on the floor (46 ayes, 0 nays) and LB 7‑62 was advanced to E & R initial (45 ayes, 2 nays). Sponsors said the amendment balances patient access to care with narrower scope and an effective date allowing insurers time to adjust.