This bill aims to amend the Code of West Virginia by introducing two new sections that specifically address the coverage and treatment of Pediatric Acute-Onset Neuroimmune Disorders (PANS and PANDAS) under Medicaid and health benefit plans. It defines these disorders and mandates that any eligible Medicaid enrollee must receive coverage for medically necessary diagnosis and treatment, as ordered by a licensed physician and supported by peer-reviewed medical literature. The bill outlines the scope of treatment, which includes diagnostic testing, pharmaceutical treatments, immune-modulating therapies, and behavioral services, while ensuring that coverage cannot be denied or limited based on the presence of behavioral or psychiatric symptoms.

Additionally, the bill emphasizes the need for education among Medicaid providers to improve the evaluation and treatment rates for these disorders, highlighting key symptoms and associations with infections. It also allows the Department of Human Services to propose rules for legislative approval to implement these provisions. Overall, the bill seeks to enhance healthcare access and treatment options for children suffering from PANS and PANDAS in West Virginia.

Statutes affected:
Introduced Version: 9-5-20a, 33-25A-8z