The proposed bill amends the Michigan Insurance Code to require health insurance policies issued or renewed after the effective date to cover the prophylaxis, diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Coverage must include a range of treatments as prescribed by a physician, such as antibiotics, medication, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. Insurers are prohibited from imposing higher copayments, deductibles, or coinsurance for these treatments compared to other benefits, and they must provide timely authorization for necessary treatments.

Additionally, the bill stipulates that insurers cannot deny or delay coverage based on previous treatments or diagnoses, and they must adhere to established treatment recommendations from a medical professional consortium. Coverage for prescribed therapies cannot be limited over the insured's lifetime, and specific coding for these disorders must align with guidelines from the National Center for Health Statistics and ICD-10-CM. The bill applies to all existing and future health insurance policies covering Michigan residents, effective 90 days after enactment.

Statutes affected:
Senate Introduced Bill: 500.100, 500.8302