WEST VIRGINIA LEGISLATURE

2026 REGULAR SESSION

Introduced

House Bill 5004

By Delegate Masters

[Introduced January 30, 2026; referred to the Committee on Health and Human Resources]

A BILL to amend the Code of West Virginia, 1931, as amended, by adding two new sections, designated §9-5-20a and §33-25A-8z, relating to acute-onset neuroimmune disorders; providing definitions; authorizing health coverage; clarifying the scope of treatment; providing education to providers; and authorizing rulemaking.

Be it enacted by the Legislature of West Virginia:

CHAPTER 9. HUMAN SERVICES.

Article 5.   Miscellaneous Provisions.

§9-5-20a. Medicaid program; acute-onset neuroimmune disorders; evaluation and classification.

(a) Definitions. – For purposes of this section:

"Pediatric Acute-Onset Neuroimmune Disorders" means Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), as recognized by the National Institutes of Health.

(b) Coverage required. – Any enrollee in Medicaid who is eligible for services subject to this chapter shall be provided coverage for the medically necessary diagnosis and treatment of Pediatric Acute-Onset Neuroimmune Disorders when such services are ordered by a licensed physician and are supported by peer-reviewed medical literature or generally accepted standards of care.

(c) Scope of treatment. – Covered services may include, but are not limited to:

(1) Diagnostic testing and clinical evaluation;

(2) Pharmaceutical treatments, including antimicrobial and anti-inflammatory therapies;

(3) Immune-modulating therapies when medically necessary; or

(4) Behavioral, psychiatric, and rehabilitative services related to PANS and PANDAS.

(d) Parity. – Coverage under this section shall not be denied, limited, or subject to more restrictive utilization management solely because the disorder presents with behavioral or psychiatric symptoms. Coverage shall comply with state and federal mental health parity requirements.

(e) Medicaid. – The Bureau for Medical Services shall recognize Pediatric Acute-Onset Neuroimmune Disorders, as recognized by the National Institute of Health, as covered conditions under the Medicaid program and shall apply medical necessity criteria consistent with this section.

(f) Education. – Medicaid providers shall be educated by the Bureau for Public Health in an effort to increase the rate of evaluation and treatment for PANS and PANDAS.  Providers should be made aware of:

(1) Presence of obsessive compulsive disorder and/or tics;

(2) Symptoms begin between age three and puberty;

(3) Acute-onset and episodic (relapsing-remitting) course;

(4) Association with Group A Streptococcal (GAS) infection; and

(5) Association with Neurological Abnormalities disease.

(g) Rulemaking. – The Department of Human Services may propose rules for legislative approval in accordance with the provisions of §29A-3-1 et seq. of this code to implement the provisions of this section.

chapter33.  insurance.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8z. Coverage of acute-onset neuroimmune disorders.

(a) Definitions. – For purposes of this section:

"Pediatric Acute-Onset Neuroimmune Disorders" means Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), as recognized by the National Institutes of Health.

(b) Coverage required. – A health benefit plan subject to this chapter shall provide coverage for the medically necessary diagnosis and treatment Of Pediatric Acute-Onset Neuroimmune Disorders when such services are ordered by a licensed physician and are supported by peer-reviewed medical literature or generally accepted standards of care.

(c) Scope of treatment. – Covered services may include, but are not limited to:

(1) Diagnostic testing and clinical evaluation;

(2) Pharmaceutical treatments, including antimicrobial and anti-inflammatory therapies;

(3) Immune-modulating therapies when medically necessary; or

(4) Behavioral, psychiatric, and rehabilitative services related to PANS and PANDAS.

(d) Parity. – Coverage under this section shall not be denied, limited, or subject to more restrictive utilization management solely because the disorder presents with behavioral or psychiatric symptoms. Coverage shall comply with state and federal mental health parity requirements.

(e) Medicaid. – The Bureau for Medical Services shall recognize Pediatric Acute-Onset Neuroimmune Disorders, as recognized by the National Institute of Health, as covered conditions under the Medicaid program and shall apply medical necessity criteria consistent with this section.

NOTE: The purpose of this bill is to provide health coverage for PANS/PANDAS.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.