Bill > HB5136

This bill requires the Michigan Department of Health and Human Services to provide medical assistance program coverage for prophylaxis, diagnosis, and treatment of two specific pediatric neurological disorders: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute Onset Neuropsychiatric Syndrome (PANS). The coverage must include various treatments like antibiotics, behavioral therapies, medications, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy, prescribed by a physician. The bill mandates that these services cannot have higher copayments or deductibles than other medical assistance benefits, and prior authorizations must be processed quickly based on the severity of the patient's condition. The department is prohibited from denying or delaying coverage based on previous treatments or diagnostic history, and lifetime treatment coverage cannot be limited except by eligibility period. For billing purposes, these disorders should be coded as autoimmune encephalopathy under specific medical coding standards. The new coverage requirements will apply to existing medical assistance programs 90 days after the bill's enactment, ensuring timely access to critical neurological treatments for children.

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https://legislature.mi.gov/Bills/Bill?ObjectName=2025-HB-5136