THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY HESS, BAKER, FLECK, MAJOR, CALTAGIRONE, CARROLL, CAUSER, COHEN, D. COSTA, J. EVANS, GOODMAN, GROVE, HARKINS, HARRIS, KAUFFMAN, M. K. KELLER, KIRKLAND, KORTZ, KOTIK, KULA, MAHONEY, MILLARD, PEIFER, PICKETT, RAPP, SWANGER, TALLMAN, YOUNGBLOOD, MOUL, BENNINGHOFF, MURT, KAVULICH, DENLINGER, BRADFORD, TRUITT, BRIGGS, MILLER, SCAVELLO, WATSON, GABLER, KILLION, FREEMAN, M. SMITH, HORNAMAN, HENNESSEY, R. BROWN, BEAR, PAYNE, CONKLIN, STEVENSON AND PERRY, JANUARY 27, 2011

AS REPORTED FROM COMMITTEE ON HUMAN SERVICES, HOUSE OF REPRESENTATIVES, AS AMENDED, DECEMBER 14, 2011   

AN ACT

Establishing a task force on Lyme disease and related maladies;

and providing for powers and duties of the task force, the

Department of Health, the Department of Conservation and

Natural Resources and the Pennsylvania Game Commission and

for required coverage.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

This act shall be known and may be cited as the Lyme and

Related Tick-Borne Disease Surveillance, Education, Prevention

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and Treatment Act.

Section 2.  Findings.

The General Assembly finds and declares as follows:

(1)  Lyme disease and other tick-borne diseases are

carried primarily by ticks and pose a serious threat to the

quality of life of many citizens of this Commonwealth.

(2)  The most common way to acquire Lyme disease is to be

bitten by a tick that carries the spirochete.

(3)  The Centers for Disease Control and Prevention (CDC)

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report that since 2001, Pennsylvania has ranked among the top

three states in the nation with the number of reported cases

of Lyme disease.

(3) (4)  In 2009, 4,950 confirmed cases of Lyme disease

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were reported in this Commonwealth, making Pennsylvania the

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highest in the nation with reported cases of Lyme disease.

(4) (5)  Lyme disease is most prevalent in southeastern

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Pennsylvania, but it is found across this Commonwealth.

(5) (6)  With proper precautions taken while engaged in

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outdoor activities, people can greatly reduce their chances

of tick pathogen transmission by making sure that frequent

tick checks are made and ticks are removed and disposed of

promptly and properly.

(6) (7)  The early clinical diagnosis and appropriate

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treatment of these tick-borne disorders and diseases can

greatly reduce the risks of continued, diverse and chronic

signs and symptoms which can affect every system and organ of

the human body and often every aspect of life.

(7) (8)  Left untreated, Lyme disease can cause a number

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of signs and symptoms which can become quite severe.

(8) (9)  Because the rate of progress of the disease and

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differing individual responses to treatment, some patients

may have signs and symptoms that linger for months or even

years following treatment.

Section 3.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Board."  The Pennsylvania State Board of Medicine, the State

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Board of Osteopathic Medicine and the State Board of Nursing.

"Department."  The Department of Health of the Commonwealth.

"Licensee."  A licensed physician or certified registered

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nurse practitioner.

"Long-term antibiotic or antimicrobial therapy."

Administration of oral, intramuscular or intravenous antibiotics

or antimicrobial medications, singly or in combination, for

periods of more than four weeks.

"Lyme disease."  The clinical diagnosis of the presence in a

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patient of signs and symptoms compatible with acute infection

with Borrelia burgdorferi or related Borrelioses, or with the

signs and symptoms of late stage or chronic infection with

Borrelia burgdorferi, or with complications related to such an

infection. The term includes infection which meets the

surveillance criteria set forth by the United States Centers for

Disease Control and Prevention and also includes other acute and

chronic manifestations of such an infection as determined by a

physician.

"Lyme disease."  The clinical diagnosis of a patient by a

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licensed physician or certified registered nurse practitioner of

the presence of signs or symptoms compatible with acute, late-

stage, persistent or chronic infection with Borrelia burgdorferi

or complications related to such infection or with such other

strains of Borrelia that are recognized by the Centers for

Disease Control and Prevention as a cause of Lyme disease. The

term includes infection which meets the surveillance criteria

set forth by the Centers for Disease Control and Prevention and

also includes other acute and chronic manifestations of such an

infection as determined by a physician.

"Other health impairment."  As defined by the Individuals

with Disabilities Education Act (Public Law 91-230, 20 U.S.C. §

1400 et seq.).

"Related tick-borne illnesses."  Cases of Bartonellosis,

Babesiosis/Piroplasmosis, Anaplasmosis, Ehrlichiosis and other

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tick-transmissible illnesses as may be empirically associated

with Lyme disease.

"Surveillance case definitions."  The Case Definitions for

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Public Health Surveillance, published by the Centers for Disease

Control and Prevention, which provide uniform criteria for

reporting cases to increase the specificity of reporting and

improving the comparability of diseases reported from different

geographic areas. As further noted by the CDC, surveillance case

definitions establish uniform criteria for disease reporting and

should not be used as the sole criteria for establishing

clinical diagnoses, determining the standard of care necessary

for a particular patient, setting guidelines for quality

assurance or providing standards for reimbursement.

"Therapeutic purpose."  The use of antibiotics to control a

patient's symptoms or signs determined by a physician as

reasonably related to Lyme disease and its sequelae or related

tick-borne illnesses.

Section 4.  Legislative intent.

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It is the intent of the General Assembly to provide the

public with information and education to create greater public

awareness of the dangers of and measures available to prevent

Lyme disease and related maladies.

Section 5 4.  Task force.

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(a)  Establishment.--The department shall establish, to the

extent funds are appropriated specifically for the purposes of

this act, a task force on Lyme disease and related tick-borne

diseases.

(a.1)  Funding.--The department shall identify and apply for

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public and private grants and funding in order to carry out the

requirements of this act to establish the task force.

(b)  Purpose.--The task force shall investigate and make

recommendations to the department regarding:

(1)  The surveillance and prevention of Lyme disease and

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associated tick-borne diseases in this Commonwealth.

(2)  Raising awareness about the long-term effects of the

misdiagnosis of Lyme disease.

(3)  The development of a program of general public

information and education regarding Lyme disease. and health

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care professional information and education regarding Lyme

disease which shall include the broad spectrum of scientific

and treatment views regarding Lyme disease and related tick-

borne illnesses, including evidence-based, multiple standards

of care and their respective evidence bases for all stages of

Lyme disease and related tick-borne illnesses.

(4)  Cooperation with the Pennsylvania Game Commission to

disseminate the information required under paragraph (3) to

licensees of the commission and the general public.

(5)  Cooperation with the Department of Conservation and

Natural Resources to disseminate the information required

under paragraph (3) to the general public and visitors of

State parks and lands.

(6)  Cooperation with the Department of Environmental

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Protection to test ticks for Lyme disease and other tick-

borne infections and provide results, including infection

rates across this Commonwealth, on their public Internet

website.

(7)  Cooperation with the Department of Education to:

(i)  Disseminate the information required under

paragraph (3) to school administrators, faculty, staff,

parents, guardians and students.

(ii)  Determine the role schools may play in the

prevention of Lyme disease, including, but not limited

to, prompt removal and reporting of tick removals to

State officials.

(iii)  Review and update policies to recognize

chronic Lyme disease and related tick-borne illnesses as

"other health impairment."

(c)  Composition.--The task force shall be composed of the

following individuals:

(1)  The Secretary of Health or a designee.

(2)  The Insurance Commissioner or a designee.

(3)  The Secretary of Education or a designee.

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(3) (4)  The Deputy Secretary for Conservation and

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Engineering Services in the Department of Conservation and

Natural Resources or a designee.

(4) (5)  The Director of the Bureau of Information and

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Education of the Pennsylvania Game Commission or a designee.

(5)  Two physicians licensed in this Commonwealth who are

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knowledgeable concerning treatment of early and late stage

Lyme disease and who are members of the International Lyme

and Associated Diseases Society.

(6)  Two physicians, with at least one licensed in this

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Commonwealth, who are knowledgeable concerning treatment of

early, late-stage and chronic/persistent Lyme disease and who

are members of the International Lyme and Associated Diseases

Society.

(7)  One physician licensed in this Commonwealth who is

knowledgeable concerning treatment of early, late-stage and

chronic/persistent Lyme disease and who specializes in

infectious diseases.

(8)  One physician licensed in this Commonwealth who is

knowledgeable concerning treatment of early, late-stage and

chronic/persistent Lyme disease and who specializes in

neurology.

(6) (9)  An epidemiologist licensed in this Commonwealth

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having expertise in spirochetes and related infectious

diseases.

(7) (10)  Two individuals representing Lyme disease

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support groups.

(d)  Convening.--The task force shall convene within 90 days

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after all appointments have been made and shall meet at least

quarterly.

(11)  One individual who is a Lyme disease patient or a

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family member of a patient.

(12)  Two registered nurses licensed in this

Commonwealth, one of which should be a certified registered

nurse practitioner.

(13)  The Director of Vector Management of the Department

of Environmental Protection.

(14)  An entomologist who has experience in tick

identification and tick-borne diseases.

(15)  Two practitioners of veterinary medicine with at

least one licensed in this Commonwealth with experience in

tick-borne diseases.

(d)  Convening.--

(1)  Within 45 days of the effective date of this act,

the Secretary of Health shall appoint the members of the task

force. The Secretary of Health shall appoint a chairman of

the task force.

(2)  The task force shall convene within 90 days of the

effective date of this act and shall meet quarterly.

(3)  The task force shall issue a report with

recommendations to the Secretary of Health within one year of

its first meeting. The report shall also be transmitted to

the relevant committees of the House of Representatives.

Nothing in this act shall prohibit the task force from making

interim reports, taking agreed-upon immediate actions or

responding to requests for such reports.

(e)  Compensation and expenses.--The members of the task

force shall receive no compensation for their services but shall

be reimbursed for actual and necessary expenses incurred in

performance of their duties. Reimbursement shall be provided by

the department.

(f)  Department.--The department shall, to the extent funds

are appropriated specifically for the purposes of this act, have

the following powers and duties:

(1)  Develop a program of general public information and

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education regarding Lyme disease.

(1)  Develop a program of general public, health care

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professional and governmental agency information and

education regarding Lyme disease which shall include the

broad spectrum of scientific and treating views regarding

Lyme disease and related tick-borne illnesses, including

multiple standards of care available for all stages of Lyme

disease and related tick-borne illnesses.

(2)  Develop an intensive program, including active

population-based surveillance, active tick surveillance and

sentinel (nonhuman) data to provide a better understanding of

diseases, geographic hot spots and infectivity to be used in

targeting prevention and education efforts.

(2) (3)  Cooperate with the Pennsylvania Game Commission

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to disseminate the information required under paragraph (1)

to licensees of the Pennsylvania Game Commission and the

general public.

(3) (4)  Cooperate with the Department of Conservation

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and Natural Resources to disseminate the information required

under paragraph (1) to the general public and visitors of

State parks and lands.

(4) (5)  Cooperate with the professional associations of

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health care professionals to provide the education program

for professionals required under paragraph (1).

(6)  Cooperate with the Department of Education to:

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(i)  Disseminate the information under paragraph (1)

to school administrators, school nurses, faculty and

staff, parents, guardians and students.

(ii)  Determine what role schools may play in the

prevention of Lyme disease, including, but not limited

to, prompt removal and reporting of tick removals to

parents, guardians and State officials.

(iii)  Review and update policies to recognize

chronic Lyme disease and related tick-borne illnesses as

"other health impairment" potentially requiring

accommodations.

Section 6 5.  Required coverage.

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(a)  Tick-borne illnesses.--Except as provided in subsection

(b), every health care policy which is delivered, issued for

delivery, renewed, extended or modified in this Commonwealth by

a health insurer must cover prescribed treatment for Lyme

disease or related tick-borne illnesses if the diagnosis and

treatment plan are documented in the patient's medical record,

including and it is documented in the patient's medical record

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that the patient has been properly informed of multiple

standards of care, risks and benefits and able to exercise

informed consent. Such treatment plans may include long-term

therapies, long-term antibiotic or antimicrobial therapy and

treatment as prescribed by the patient's attending physician.

(b)  Exception.--Subsection (a) shall not apply to any of the

following types of insurance:

(1)  Hospital indemnity.

(2)  Accident.

(3)  Specified disease.

(4)  Disability income.

(5)  Dental.

(6)  Vision.

(7)  Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS) supplement.

(8)  Medicare supplement.

(9)  Long-term care.

(10)  Other limited insurance benefit plans.

Section 7 20.  Effective date.

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This act shall take effect immediately.