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HOUSE BILL NO. 6148
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406pp.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406pp. (1) A health insurance policy delivered, issued 1
for delivery, or renewed in this state after the effective date of 2
the amendatory act that added this section must provide coverage 3
for the prophylaxis, diagnosis, and treatment of pediatric 4
autoimmune neuropsychiatric disorders associated with streptococcal 5
infections and pediatric acute onset neuropsychiatric syndrome that 6
June 30, 2026, Introduced by Reps. DeBoyer and Breen and referred to Committee on Insurance.
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DAW H02263'25_HB6148_INTR_1 31oi58
is prescribed or ordered by a physician or provider, including, but 1
not limited to, antibiotics, medication and behavioral therapies to 2
manage neuropsychiatric symptoms, immunomodulating medicines, 3
plasma exchange, and the use of intravenous immunoglobulin therapy. 4
(2) Benefits under a health insurance policy subject to this 5
section must not be subject to any greater copayment, deductible, 6
or coinsurance than any other benefits provided by the insurer. 7
(3) A required authorization for pediatric autoimmune 8
neuropsychiatric disorders associated with streptococcal infections 9
and pediatric acute onset neuropsychiatric syndrome prophylaxis, 10
diagnosis, or treatment must be provided in a timely manner that is 11
appropriate for the severity of an insured's condition. Coverage 12
must be provided in a timely manner under standards for urgent 13
treatments. 14
(4) An insurer that delivers, issues for delivery, or renews 15
in this state a health insurance policy shall not deny or delay 16
coverage for pediatric autoimmune neuropsychiatric disorders 17
associated with streptococcal infections or pediatric acute onset 18
neuropsychiatric syndrome treatment or therapies under this section 19
because the insured previously received any treatment, including 20
the same or similar treatment, for pediatric autoimmune 21
neuropsychiatric disorders associated with streptococcal 22
infections, pediatric acute onset neuropsychiatric syndrome, or any 23
other diagnosed condition or because the insured was diagnosed with 24
or received treatment for the insured's condition under a different 25
diagnostic name, including, but not limited to, autoimmune 26
encephalopathy. 27
(5) An insurer that delivers, issues for delivery, or renews 28
in this state a health insurance policy shall not limit coverage of 29
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DAW H02263'25_HB6148_INTR_1 31oi58
immunomodulating therapies for pediatric autoimmune 1
neuropsychiatric disorders associated with streptococcal infections 2
or pediatric acute onset neuropsychiatric syndrome in a manner that 3
is inconsistent with the treatment recommendations under subsection 4
(6) and shall not require a trial of therapies that treat only 5
neuropsychiatric symptoms before authorizing coverage of 6
immunomodulating therapies under this section, including, but not 7
limited to, intravenous immunoglobulin therapy. 8
(6) For the purposes of this section, when providing coverage 9
of pediatric autoimmune neuropsychiatric disorders associated with 10
streptococcal infections and pediatric acute onset neuropsychiatric 11
syndrome prescribed therapies and treatments, an insurer shall 12
adhere to the treatment recommendations developed by a medical 13
professional consortium convened for the purposes of researching, 14
identifying, and publishing clinical practice guidelines and 15
evidence-based standards for prophylaxis, diagnosis, and treatment 16
of the disorders or syndromes that are accessible for medical 17
professionals and are based on evidence of positive patient 18
outcomes. A review of coverage is considered reasonable only if it 19
references all peer-reviewed published standards of care 20
development by medical professionals with expertise in pediatric 21
autoimmune neuropsychiatric disorders associated with streptococcal 22
infections and pediatric acute onset neuropsychiatric syndrome 23
prophylaxis, diagnosis, and treatment. 24
(7) If an insured has filed an appeal with the department 25
because of being denied coverage for therapy or treatment under 26
this section, the department must refer and give deference to the 27
treatment recommendations developed by a medical professional 28
consortium convened for the purposes of researching, identifying, 29
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DAW H02263'25_HB6148_INTR_1 31oi58
and publishing clinical practice guidelines and evidence-based 1
standards for prophylaxis, diagnosis, and treatment of pediatric 2
autoimmune neuropsychiatric disorders associated with streptococcal 3
infections and pediatric acute onset neuropsychiatric syndrome that 4
are accessible for medical professionals and are based on evidence 5
of positive patient outcomes. 6
(8) Coverage under this section for any form of therapy or 7
treatment that is prescribed or ordered by a physician or provider 8
must not be limited over a lifetime of an insured, except as 9
limited by policy period. 10
(9) For billing and diagnosis purposes, pediatric autoimmune 11
neuropsychiatric disorders associated with streptococcal infections 12
and pediatric acute onset neuropsychiatric syndrome must be coded 13
as autoimmune encephalopathy and coded as D89.89 (other specified 14
disorders involving the immune mechanism not otherwise specified) 15
per the National Center for Health Statistics and ICD-10-CM unless 16
the American Medical Association and the Centers for Medicare and 17
Medicaid Services create and assign a specific code for pediatric 18
autoimmune neuropsychiatric disorders associated with streptococcal 19
infections and pediatric acute onset neuropsychiatric syndrome. If 20
the American Medical Association and the Centers for Medicare and 21
Medicaid Services create and assign a specific code for pediatric 22
autoimmune neuropsychiatric disorders associated with streptococcal 23
infections and pediatric acute onset neuropsychiatric syndrome, 24
pediatric autoimmune neuropsychiatric disorders associated with 25
streptococcal infections and pediatric acute onset neuropsychiatric 26
syndrome may be coded as autoimmune encephalopathy, PANDAS, or 27
PANS. If the American Medical Association adopts the ICD-11-CM, 28
pediatric autoimmune neuropsychiatric disorders associated with 29
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streptococcal infections and pediatric acute onset neuropsychiatric 1
syndrome must be coded under 8E4A – paraneoplastic or autoimmune 2
disorders of the central nervous system, brain, or spinal cord. 3
(10) The amendatory act that added this section applies to 4
existing health insurance policies and health insurance policies 5
delivered, executed, issued, amended, adjusted, or renewed in this 6
state, or outside of this state if covering residents of this 7
state, beginning 90 dates after the date this amendatory act is 8
enacted into law. 9