MI HB5136

Requires Michigan's Medicaid program to cover prophylaxis, diagnosis, and treatment for PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute Onset Neuropsychiatric Syndrome), including antibiotics, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy

Prohibits imposing higher copayments, deductibles, or coinsurance for these conditions compared to other Medicaid benefits

Mandates timely prior authorization appropriate to the severity of the patient's condition, with coverage provided under urgent treatment standards

Bars denial or delay of coverage based on previous treatments received or because the condition was diagnosed under a different name such as autoimmune encephalopathy

Specifies billing codes (D89.89 under ICD-10-CM) for PANDAS/PANS until specific codes are created, with the law taking effect 90 days after enactment