This bill amends the Michigan Insurance Code of 1956 by adding a new section, 3406pp, which mandates that health insurance policies delivered, issued, or renewed in the state must provide coverage for the prophylaxis, diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. The coverage must include a range of treatments prescribed by a physician, such as antibiotics, medication, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. Additionally, the bill stipulates that benefits for these treatments cannot have higher copayments, deductibles, or coinsurance than other benefits, and insurers must provide timely authorization for necessary treatments.

Furthermore, the bill prohibits insurers from denying or delaying coverage based on previous treatments or diagnoses and requires adherence to treatment recommendations developed by a medical professional consortium. It also ensures that coverage for prescribed therapies cannot be limited over a lifetime, except as dictated by the policy period. For billing and diagnosis, the bill specifies that these disorders should be coded as autoimmune encephalopathy unless a specific code is created by relevant medical authorities. The provisions of this bill will apply to existing and new health insurance policies starting 90 days after the enactment of the amendatory act.

Statutes affected:
Senate Introduced Bill: 500.100, 500.8302