HB 5004
Relating generally to PANS and PANDAS.
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to improve healthcare coverage for children diagnosed with Pediatric Acute-Onset Neuroimmune Disorders (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). It establishes definitions for these disorders, mandates coverage for medically necessary diagnosis and treatment by licensed physicians, and requires education for Medicaid providers regarding these conditions. The bill also ensures parity in coverage for behavioral and psychiatric symptoms associated with these disorders.
Key provisions
- Defines ‘Pediatric Acute-Onset Neuroimmune Disorders’ as PANS and PANDAS.
- Requires Medicaid to cover diagnosis and treatment for these disorders when ordered by a licensed physician.
- Specifies covered services including diagnostic testing, pharmaceutical treatments, immune-modulating therapies, and behavioral/psychiatric services.
- Ensures parity in coverage, preventing denial or restriction based on behavioral or psychiatric symptoms.
- Mandates education for Medicaid providers regarding PANS and PANDAS.
- Authorizes rulemaking to implement the provisions of the bill.
- Requires health benefit plans to provide coverage for these disorders.
- Directs the Bureau for Medical Services to recognize these disorders as covered conditions under the Medicaid program.
Who is affected
- Children with PANS and PANDAS
- Medicaid recipients
- Healthcare providers (particularly Medicaid providers)
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Primary sponsor
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