TennCare - As enacted, enacts "Lucca's Law," which addresses TennCare coverage of treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset , the official text

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                        ~tate of \!tennessee

                          PUBLIC CHAPTER NO. 482

                                                  HOUSE BILL NO. 411

By Representatives Lynn, Haston, Cepicky, Littleton, Faison, Lafferty, Carringer, Helton-
                                                   Haynes, Terry, Davis

                                       Substituted for: Senate Bill No. 1426

         By Senators Watson, Akbari, Bailey, Campbell, Jackson, Lowe, Pody, Reeves

         AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to
pediatric medical disorders.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

          SECTION 1. This act is known and may be cited as "Lucca's Law."

          SECTION 2. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:

                    (a) As used in this section, "managed care organization" or "MCO" means a
          health maintenance organization, behavioral health organization, or managed health
          insurance issuer that participates in the TennCare program.

                    (b) The division of TennCare may require every group health insurance contract,
          and every group hospital or medical expense insurance policy, plan, and group policy
          delivered, issued for delivery, amended, or renewed in this state by an MCO on or after
          January 1, 2026, to provide coverage for physician prescribed treatment, deemed
          medically necessary pursuant to § 71-5-144, of pediatric autoimmune neuropsychiatric
          disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset
          neuropsychiatric syndrome (PANS). Such treatment may include antibiotics, medication,
          behavioral therapies to manage neuropsychiatric symptoms, immunomodulating
          medicines, plasma exchange, and intravenous immunoglobulin therapy. Benefits
          provided under this section are not subject to a greater co-payment, deductible, or
          coinsurance than another similar benefit provided by the MCO. Coverage authorization
          must be provided in a timely manner consistent with department of commerce and
          insurance rules for urgent treatments adopted pursuant to the Uniform Administrative
          Procedures Act, compiled in title 4, chapter 5.

                    (c) A group or individual policy of accident and health insurance or managed care
          must not deny or delay coverage for medically necessary treatment under this section
          solely because the recipient previously received treatment, including the same or similar
          treatment, for PANDAS or PANS, or because the recipient has been diagnosed with or
          received treatment for their condition under a different diagnostic name, such as
          autoimmune encephalopathy. For the purposes of this section, when medically
          necessary pursuant to § 71-5-144, coverage of PANDAS and PANS may take into
          consideration the treatment recommendations developed by a medical professional
          consortium convened for the purposes of researching, identifying, and publishing best
          practice standards for diagnosis and treatment of such disorders that are accessible for
          medical professionals and are based on evidence of positive patient outcomes. This
          section does not prevent an MCO from requesting treatment notes and anticipated
          duration of treatment and outcomes.

                    (d) For billing and diagnosis purposes, PANDAS and PANS must be coded as
          autoimmune encephalitis until the American Medical Association and the centers for
           medicare and medicaid services create and assign a specific code for PANDAS and
          PANS. Thereafter, PANDAS and PANS may be coded as autoimmune encephalitis,
           PANDAS, or PANS. If a new common name or code is utilized for PANDAS and PANS
          then this section applies to patients with conditions under that new common name o~
           code.
HB411
          SECTION 3. This act takes effect upon becoming a law, the public welfare requiring it.

                                                                  2
         HOUSE BILL NO. 411

PASSED:  April 22, 2025

                                               ·- J l

                         CAMERON SEXTON, SPEAKER
                         HOUSE OF REPRESENTATIVES

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                                 \  RANDY MCNALJ\'

                                 SPEAKER OF THE SENATE

t'Vh •o 1-s+ APPROVED this :;.,     2025
         day of

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BILL LEE, GOVERNOR