MI SB1030

Requires health insurance policies in Michigan to cover prophylaxis, diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute onset neuropsychiatric syndrome (PANS), including antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy.

Prohibits insurers from applying greater copayments, deductibles, or coinsurance to PANDAS/PANS coverage than other covered benefits, and requires authorizations and coverage decisions to be provided on urgent care timelines appropriate to condition severity.

Prevents insurers from denying or delaying coverage based on previous treatments for the same or related conditions, including when diagnosed under different names such as autoimmune encephalopathy.

Prohibits insurers from limiting immunomodulating therapies inconsistently with established medical consortium treatment recommendations and prohibits requiring trials of symptom-only therapies before approving immunomodulating treatments.

Requires insurers to reference evidence-based clinical practice guidelines from medical professionals with relevant expertise when reviewing coverage decisions, and mandates the Michigan Department of Insurance defer to such established standards when reviewing coverage denials, with no lifetime limits on therapy coverage except by policy period.