This bill amends the Social Welfare Act to include a new section, 109v, which mandates that the Michigan Department of Health and Human Services provide coverage under the medical assistance program 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, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. Additionally, the bill stipulates that benefits under this program cannot have higher copayments, deductibles, or coinsurance than other benefits, and prior authorization for treatments must be timely and appropriate to the severity of the condition.

Furthermore, the bill ensures that coverage cannot be denied or delayed based on previous treatments or diagnoses, and it prohibits lifetime limits on therapy or treatment prescribed by a physician, except as limited by eligibility periods. For billing and diagnosis, these disorders must be coded as autoimmune encephalopathy unless specific codes are created by the American Medical Association and the Centers for Medicare and Medicaid Services. The provisions of this bill will apply to existing medical assistance coverage starting 90 days after its enactment.

Statutes affected:
House Introduced Bill: 400.1, 400.119