Tennessee Senate Bill SB1426

Tennessee 2025-2026 Regular Session

• Introduced: 2/6/25
• Chaptered: 5/27/25
• Passed: 5/27/25

Caption

AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to pediatric medical disorders.

Summary

SB1426, known as “Lucca’s Law,” requires or authorizes TennCare’s 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). The bill applies to group health insurance contracts and group hospital or medical expense policies issued, delivered, amended, or renewed on or after January 1, 2026, by managed care organizations participating in TennCare. Covered treatment may include antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. The bill also prohibits insurers 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 AMA and CMS create specific codes, after which those codes may be used as well. The act takes effect immediately upon becoming law.

Impact

The bill amends Tennessee Code Annotated Title 71 by adding a new section governing coverage for PANDAS and PANS treatment in TennCare-related managed care and certain health insurance policies. It expands the scope of medically necessary pediatric neuropsychiatric treatment that may be required under insurance coverage rules, limits cost-sharing by tying benefits to comparable covered services, and establishes coding rules for claims processing until national coding systems create specific codes. The measure primarily affects TennCare managed care organizations, insurers offering group or individual accident and health coverage, pediatric patients with these disorders, and providers seeking reimbursement for diagnosis and treatment.

Sentiment

The available voting history suggests broad support, with the Senate Commerce and Labor Committee recommending passage unanimously, 9-0. The bill’s framing as “Lucca’s Law” and its focus on access to treatment for children indicate a generally sympathetic and protective posture toward affected families. No committee transcript was provided, but the lack of recorded opposition in the committee vote suggests limited formal resistance at that stage.

Contention

The main policy issues likely concern insurance coverage mandates, medical necessity standards, and the use of treatments that can be expensive or clinically debated, such as intravenous immunoglobulin therapy and plasma exchange. The bill addresses a potential barrier to care by preventing denials based on prior treatment or alternate diagnoses, which may be welcomed by families and advocates but could raise concerns for insurers and managed care organizations about utilization control and cost. Another point of contention is the interim coding requirement, which may be viewed as a practical billing solution by supporters but as an administrative complication by payers and claims processors.