Beginning January 1, 2027, covered health plans must cover doctor-recommended treatment for two defined disorders affecting children and adolescents.
Starting January 1, 2027, covered plans must cover doctor-recommended treatment for two defined disorders in children and adolescents. Policies with limited benefits are excluded, and federal law may limit the rule for self-funded plans.
Covered plans must provide coverage for treatment of both disorders. The disorders involve sudden or recurring neuropsychiatric symptoms or behavior changes in a child or adolescent; one is linked to Group A strep infection, and the other must not be explained by another known neurologic or medical disorder. A licensed physician must recommend the treatment. Policies limited to a specified disease or other limited benefits are excluded. Self-funded plans are covered only to the extent federal law does not preempt this rule. The coverage rule applies on or after January 1, 2027.
No hearings or votes scheduled.