Health Evidence Review Commission (HERC) Coverage Guidance: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)
On May 19, 2022, Oregon’s Health Evidence Review Committee voted to ADOPT the guidance put forth for IVIG Coverage for PANDAS/PANS! It is anticipated to go into effect 1/1/2023. The Oregon HERC is the body responsible for determining what will be covered by Medicaid and what will not.
Oregon Herc Coverage Guidance for PANS & PANDAS – Read the full document
Previous Legislative Action
Upcoming Hearings – Thursday, May 19th
- Values-Based Subcommittee
- Health Evidence Review Committee
Call to Action
ASPIRE Board Testimony Letters
Oregon’s next Health Evidence Review Commission has PANDAS/PANS on its April 7th agenda. Join NWPPN in support as we continue to advocate specifically for children on Medicaid to have access to ‘medically necessary’ care. Health disparity should NOT be perpetuated in the State of Oregon by ‘fail first’ requirements and a 2 specialist requirement when such specialists have no expertise and are not treating these disorders in our state.
Purpose: PANDAS/PANS review of public comments is on the agenda
Current Guidance Report Recommendation:
- Option #1 – Requires 2 failed treatments before progression to IVIG or Plasma Exchange which has to be recommended by 2 Physician Subspecialties (Neurology, Psychiatry, Rheumatology, Neurodevelopmental)
To Watch: Join Zoom Gov Meeting at https://www.zoomgov.com/j/1603991133?pwd=YzR2NHIrUOIvN05ITC9PSzhEM2lvQT09
To Testify: Sign up by 4/5 at Survey Monkey
About the HERC: The Health Evidence Review Commission reviews medical evidence in order to prioritize health spending in the Oregon Health Plan and to promote evidence-based medical practice statewide through comparative effectiveness reports, including coverage guidances and multisector interventions, health technology assessments and evidence-based practice guidelines.
The commission uses a transparent public process to ensure that its decisions are made in the best interest of patients and taxpayers while considering input from providers and members of the public, including those affected by the conditions discussed.
The Oregon HERC is the body responsible for determining what will be covered by Medicaid and what will not. They will not release their revised guidance until 11/24 so it is difficult for us to prepare how to respond until we see this. You are welcome to write a letter of support and/or to tune into the meeting.