VT S0251

Requires health insurance plans to cover medically necessary diagnosis and treatment of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)

Mandates coverage for specific treatments including antibiotics, medication therapy, mental health services, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy

Prohibits insurers from imposing higher cost-sharing requirements (copays, deductibles, coinsurance) for PANDAS/PANS treatment than for other physical or mental health conditions

Allows PANDAS and PANS to be billed using autoimmune encephalitis codes until specific diagnosis codes are established by the AMA and CMS

Takes effect January 1, 2027, applying to all health insurance plans issued or renewed on or after that date, with full compliance required by January 1, 2028