WV HB4197

Requires West Virginia's Children's Health Insurance Program (CHIP) and managed care organizations to cover medically necessary treatments for PANDAS and PANS beginning January 1, 2027

Mandated coverage includes antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy

Prohibits insurers from denying or delaying coverage based on previous treatment history or because the condition was diagnosed under a different name such as autoimmune encephalopathy

Coverage cannot be subject to higher co-payments, deductibles, or coinsurance than similar benefits, and cannot impose lifetime or policy-period limits on medically necessary treatment

Requires PANDAS and PANS to be billed as autoimmune encephalitis until specific diagnostic codes are created by the American Medical Association and Centers for Medicare and Medicaid Services