SB 447 requires Michigan health insurers to cover specific treatments for pediatric autoimmune neuropsychiatric disorders (PANS/PANDAS), including antibiotics, behavioral therapies, immunomodulating medicines, and IVIG therapy. It mandates that coverage for these conditions cannot have higher copays, deductibles, or coinsurance than other treatments, must be authorized promptly for urgent cases, and cannot be denied based on prior treatments or different diagnoses. Insurers must follow evidence-based medical guidelines developed by a consortium of experts when reviewing coverage requests, and the bill specifies standardized ICD-10 coding for billing purposes. This law directly affects children diagnosed with these conditions and all health insurers operating in Michigan, ensuring consistent access to medically necessary care.
HB 5136 requires Michigan's Medicaid program (medical assistance) to cover preventive care, diagnosis, and treatment for children with PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep) and PANS (pediatric acute onset neuropsychiatric syndrome). It mandates no higher copays or deductibles than other Medicaid services, requires timely coverage for urgent cases, and prohibits denials based on prior treatments or different diagnoses. The bill also bans lifetime limits on covered treatments like antibiotics, behavioral therapy, or IVIG therapy. This directly affects Medicaid-enrolled children diagnosed with these specific conditions.
HB 5226 requires health insurance policies sold or renewed in Michigan to cover treatment for pediatric autoimmune neuropsychiatric disorders linked to strep infections (PANS) and pediatric acute-onset neuropsychiatric syndrome (PANS), including intravenous immunoglobulin therapy. This applies to all health insurance policies delivered, issued, or renewed in Michigan or covering Michigan residents, starting 90 days after the law takes effect. The bill directly affects children diagnosed with these specific conditions by mandating insurance coverage for their treatment. It amends Michigan's insurance code to ensure these therapies are included in standard coverage without additional patient cost.
HB 5251 requires Michigan's medical assistance program (Medicaid for low-income residents) to cover prescribed pediatric extended care for children. This specifically affects low-income children in Michigan who need specialized, long-term medical care beyond standard hospital stays. The bill amends state law to mandate this coverage under existing rules for pediatric extended care (Part 219A of the Public Health Code). The coverage would apply to children receiving medically necessary care as prescribed by a doctor. The bill is contingent on the passage of companion legislation (HB 5252).
HB 5252 amends Michigan's Public Health Code to create a new licensing category for "prescribed pediatric extended care facilities," which provide specialized long-term medical care for children with complex health needs. The bill establishes specific licensing requirements for these facilities, including standards for staffing, medical oversight, and facility operations, directly affecting providers seeking to operate such services. Key provisions include adding Part 219A to the code and revising existing sections (20106, 20109, 20115, 20161) to incorporate these new requirements. This change aims to ensure consistent safety and quality standards for pediatric extended care facilities across the state. The bill is currently pending in the House Health Policy Committee.
