Oregon Statutes 743A.315 – Treatment for pediatric autoimmune neuropsychiatric disorders
(1) A health benefit plan, as defined in ORS § 743B.005, must cover the cost of up to three monthly immunomodulatory courses of intravenous immunoglobulin therapy for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, when the following conditions have been met:
(a) Clinically appropriate trials, which may be done concurrently, of two or more less-intensive treatments were:
(A) Not effective;
(B) Not tolerated; or
(C) Did not result in sustained improvement in symptoms, as measured by a lack of clinically meaningful improvement on a validated instrument directed at the patient’s primary symptom complex; and
(b) A pediatric subspecialist was consulted and the pediatric subspecialist and the patient’s primary care provider recommend the treatment. For an adolescent patient, the consultation may be with an adult subspecialist.
(2) The health benefit plan may require that the patient be clinically reevaluated at three-month intervals.
(3) This section is exempt from ORS § 743A.001. [2023 c.111 § 2]
743A.315 was added to and made a part of the Insurance Code by legislative action but was not added to ORS Chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
Sections 1, 3 and 7, chapter 111, Oregon Laws 2023, provide:
Sections 2 [743A.315] and 3 of this 2023 Act are added to and made a part of the Insurance Code. [2023 c.111 § 1]
For billing and diagnostic purposes, the coverage described in section 2 of this 2023 Act [743A.315] may be coded as autoimmune encephalitis until the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific billing and diagnostic code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome. [2023 c.111 § 3]
Section 3 of this 2023 Act is repealed on January 2, 2028. [2023 c.111 § 7]