CA AB2105

Requires health care service plans and health insurance policies issued, amended, or renewed on or after January 1, 2025, to cover prophylaxis, diagnosis, and treatment of PANDAS and PANS prescribed by treating physicians and medically necessary per national clinical practice guidelines.

Covered treatments include antibiotics, medication and behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy.

Prohibits copayments, coinsurance, deductibles, or other cost sharing for PANDAS and PANS coverage that exceed those applied to other benefits.

Prevents denial or delay of coverage based on prior PANDAS or PANS treatment, prior diagnosis under a different name (including autoimmune encephalopathy), or inconsistency with clinical guidelines for immunomodulating therapies.

Requires PANDAS and PANS to be coded as autoimmune encephalitis for billing purposes until the American Medical Association and Centers for Medicare and Medicaid Services assign specific diagnostic codes.