AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to pediatric medical disorders.
Summary
HB0411, known as “Lucca’s Law,” requires or authorizes TennCare-managed care organizations to cover medically necessary treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). Beginning January 1, 2026, the bill allows coverage for physician-prescribed treatments such as antibiotics, medications, behavioral therapies, immunomodulating drugs, plasma exchange, and intravenous immunoglobulin therapy, so long as the treatment is deemed medically necessary under existing TennCare standards.
The bill also bars insurers and managed care plans from denying or delaying coverage solely because a patient previously received similar treatment or because the condition was diagnosed under a different name, such as autoimmune encephalopathy. It directs that, for billing and diagnosis purposes, PANDAS and PANS be coded as autoimmune encephalitis until the American Medical Association and CMS create a specific code, after which the disorders may be coded under their own names or as autoimmune encephalitis. The act takes effect immediately upon becoming law.
Impact
The bill amends Tennessee Code Annotated Title 71 and affects TennCare coverage rules for managed care organizations, group health insurance contracts, and related medical expense policies. It creates a new coverage mandate framework for PANDAS and PANS treatment, ties coverage to medical necessity determinations, and limits cost-sharing by prohibiting higher copayments, deductibles, or coinsurance than comparable benefits. It also affects billing and claims processing by establishing temporary coding rules until a specific national code is created.
Sentiment
The bill appears to have been broadly supported throughout the legislative process, passing subcommittee, committee, and floor votes unanimously or overwhelmingly with no recorded opposition. The absence of recorded nays at each stage suggests strong bipartisan agreement and little public legislative resistance to the measure. The bill’s enactment and immediate effective date further indicate that lawmakers treated it as a priority health coverage measure.
Contention
The main policy issues in the bill center on insurance coverage standards, diagnostic coding, and the scope of medically necessary treatment for PANDAS and PANS. The bill anticipates disputes over whether prior treatment or alternate diagnostic labels should be used to deny coverage and resolves those in favor of continued access. It also leaves room for insurers to request treatment notes and expected duration/outcomes, reflecting a balance between coverage expansion and utilization review. No major opposition is reflected in the vote history, but the coding requirement and reliance on consortium-developed treatment recommendations suggest sensitivity to medical evidence and claims administration concerns.
A bill for an act establishing a veterans recovery pilot program and fund for the reimbursement of expenses related to providing hyperbaric oxygen treatment to eligible veterans and making appropriations.(Formerly HF 326.)
A bill for an act establishing a veterans recovery pilot program and fund for the reimbursement of expenses related to providing hyperbaric oxygen treatment to eligible veterans and making appropriations.(See HF 518.)