(a) This section applies to: (1) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State; and (2) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State. (b) An entity subject to this section shall provide coverage for medically necessary diagnosis, evaluation, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy. (c) (1) Subject to paragraph (2) of this subsection, the coverage required under this section may be subject to the annual deductibles, copayments, or coinsurance requirements imposed by an entity subject to this section for similar coverages under the same health insurance policy or contract. (2) The annual deductibles, copayments, or coinsurance requirements imposed under paragraph (1) of this subsection for the coverage required under this section may not be greater than the annual deductibles, copayments, or coinsurance requirements imposed by the entity for similar coverages. (d) (1) Except as provided for in paragraph (2) of this subsection, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis for billing and diagnosis purposes. (2) If the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute onset neuropsychiatric syndrome for billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as: (i) autoimmune encephalitis; (ii) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; or (iii) pediatric acute onset neuropsychiatric syndrome. §15-856. IN EFFECT // EFFECTIVE UNTIL DECEMBER 31, 2022 PER CHAPTERS 29 AND 31 OF 2021 SPECIAL SESSION // (a) (1) In this section the following words have the meanings indicated. (2) "COVID-19" means, interchangeably and collectively, the coronavirus known as COVID-19 or 2019-nCoV and the SARS-CoV-2 virus. (3) (i) "COVID-19 test" means an in vitro diagnostic test for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19, as described in § 3201 of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. (ii) "COVID-19 test" includes a federal Food and Drug Administration-approved, cleared, or authorized rapid point-of-care test and an at- home collection test for the detection or diagnosis of COVID-19. (4) "Health benefit plan": (i) for a small employer plan, has the meaning stated in § 15- 1201 of this title; and (ii) for an individual plan, has the meaning stated in § 15-1301 of this title. (5) (i) "Member" means an individual entitled to health care benefits under a policy issued or delivered in the State by an entity subject to this section. (ii) "Member" includes a subscriber. (b) (1) This section applies to: (i) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense- incurred basis under health insurance policies or contracts that are issued or delivered in the State; and (ii) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State. (2) This section applies to each individual and small employer health benefit plan that is issued or delivered in the State by an insurer, a nonprofit health service plan, or a health maintenance organization, irrespective of §§ 15-1207(d) and 31-116 of this article. (c) An entity subject to this section shall provide coverage for COVID-19 tests and related items and services for the administration of COVID-19 tests, including facility fees, health care practitioner fees, and evaluation of the member for purposes of determining the need for the COVID-19 test, as required by the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and any applicable federal regulations or guidance. (d) An entity subject to this section may not apply a copayment, coinsurance requirement, or deductible to coverage for COVID-19 tests and related items and services for the administration of COVID-19 tests.
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