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, PERRY, MAHER, ROCK, SAYLOR, HARPER AND BROOKS, JANUARY 27, 2011

AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, OCTOBER 1, 2012   

AN ACT

Establishing a task force on Lyme disease and related maladies;

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

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Department of Health, the Department of Conservation and

Natural Resources and the Pennsylvania Game Commission and

for required coverage; and executing prevention and education

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strategies.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

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

Related Tick-Borne Disease Surveillance, Education, Prevention

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)

report that since 2001, Pennsylvania has ranked among the top

three states in the nation with the number of reported cases

of Lyme disease.

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

reported in this Commonwealth, making Pennsylvania the

highest in the nation with reported cases of Lyme disease.

(5)  Lyme disease is most prevalent in southeastern

Pennsylvania, but it is found across this Commonwealth.

(6)  With proper precautions taken while engaged in

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.

(7)  The early clinical diagnosis and appropriate

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.

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

signs and symptoms which can become quite severe.

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

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

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

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 a patient by a

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

tick-transmissible illnesses as may be empirically associated

with Lyme disease.

"Surveillance case definitions."  The Case Definitions for

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.  Task force.

(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

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

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 and

health 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

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.

(4)  The Deputy Secretary for Conservation and

Engineering Services in the Department of Conservation and

Natural Resources or a designee.

(5)  The Director of the Bureau of Information and

Education of the Pennsylvania Game Commission or a designee.

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

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.

(9)  An epidemiologist licensed in this Commonwealth

having expertise in spirochetes and related infectious

diseases.

(10)  Two individuals representing Lyme disease support

groups.

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

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, health care

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.

(3)  Cooperate with the Pennsylvania Game Commission to

disseminate the information required under paragraph (1) to

licensees of the Pennsylvania Game Commission and the general

public.

(4)  Cooperate with the Department of Conservation and

Natural Resources to disseminate the information required

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

State parks and lands.

(5)  Cooperate with the professional associations of

health care professionals to provide the education program

for professionals required under paragraph (1).

(6)  Cooperate with the Department of Education to:

(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 5.  Required coverage.

(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, 

and it is documented in the patient's medical record 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 20.  Effective date.

This act shall take effect immediately.

Section 1.  Short title.

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

Related Tick-Borne Disease Surveillance, Education, Prevention

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

health and 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)  In 2009, 5,722 confirmed cases of Lyme disease were

reported in this Commonwealth, the highest number of cases

reported in any state and representing a 76% increase since

2006. In 2011, provisional numbers of 7,484 cases confirm

this ongoing upward trend.

(4)  These trends illustrate the World Health

Organization's (WHO) projections through 2010. The WHO states

that Lyme disease will increasingly become a public health

threat in the United States. Pennsylvania needs to be

prepared to deal with this trend, which is already being

observed in Pennsylvania's statistics.

(5)  Lyme disease is most prevalent in southeastern

Pennsylvania, but it is found across this Commonwealth.

(6)  With proper precautions taken while engaged in

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.

(7)  The early clinical diagnosis and appropriate

treatment of these tick-borne disorders and diseases can

greatly reduce the risks of continued symptoms which can

affect every system and organ of the human body and often

every aspect of life.

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

signs and symptoms which can become quite severe.

Section 3.  Legislative intent.

It is the intent of the General Assembly:

(1)  To provide the public with information and education

to create greater public awareness of the dangers of and

measures available to prevent, diagnose and treat Lyme

disease and related maladies.

(2)  To ensure that:

(i)  Licensees, insurers, patients and governmental

agencies are educated about treatment options.

(ii)  Licensees provide patients with sufficient

information about treatment options to enable patients to

make an informed choice as part of informed consent and

respect the autonomy of that choice.

(iii)  Pennsylvania government agencies provide

unbiased information regarding treatment options.

Section 4.  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

Board of Osteopathic Medicine and the State Board of Nursing.

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

"Licensee."  A licensed physician, a physician's assistant or

certified registered nurse practitioner or other licensed health

care professional.

"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 a patient by a

licensed physician or certified registered nurse practitioner of

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

stage, persistent 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

other acute and persistent manifestations of such an infection

as determined by a physician.

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

Babesiosis/Piroplasmosis, Anaplasmosis, Ehrlichiosis and other

tick-transmissible illnesses as may be empirically associated

with Lyme disease.

"Secretary."  The Secretary of Health of the Commonwealth.

"State officials."  The term includes the Secretary of

Environmental Protection.

"Task force."  The task force established by this act.

"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 5.  Task force.

(a)  Establishment.--The department shall establish a task

force on Lyme disease and related tick-borne diseases.

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

recommendations to the department regarding:

(1)  The surveillance and prevention of Lyme disease and

related tick-borne illnesses 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 and

health care professional information and education regarding

Lyme disease which shall include the broad spectrum of

scientific and treatment options regarding 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

Protection to test ticks and provide results and to publish

on its publicly accessible 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)  Update policies to recognize signs or symptoms

of Lyme disease and related tick-borne illnesses as

health impairments potentially requiring accommodations.

(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.

(4)  The Deputy Secretary for Parks and Forestry in the

Department of Conservation and Natural Resources or a

designee.

(5)  The Director of the Bureau of Information and

Education of the Pennsylvania Game Commission or a designee.

(6)  Two physicians licensed in this Commonwealth, who

are knowledgeable concerning treatment of Lyme disease and

related tick-borne illnesses and who are members of the

International Lyme and Associated Diseases Society.

(7)  Two physicians licensed in this Commonwealth who are

knowledgeable concerning treatment of Lyme disease and

related tick-borne illnesses who are members of the

Infectious Disease Society of America.

(8)  An epidemiologist licensed in this Commonwealth

having expertise in spirochetes and related infectious

diseases.

(9)  Two individuals representing Lyme disease patient

groups who may be a Lyme disease patient of a family member

of a Lyme disease patient.

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

family member of a Lyme disease patient.

(11)  Two registered nurses licensed in this

Commonwealth, one of which should be a certified registered

nurse practitioner and both of whom are knowledgeable

concerning Lyme disease and related tick-borne illnesses.

(12)  The Director of Vector Management of the Department

of Environmental Protection.

(13)  An entomologist with the Department of Entomology

of The Pennsylvania State University who has experience in

tick identification and tick-borne diseases.

(14)  A registered school nurse licensed in this

Commonwealth who is knowledgeable concerning Lyme disease and

tick-borne illnesses.

(15)  Two veterinarians licensed in this Commonwealth, at

least one of whom is a veterinary epidemiologist and both of

whom are knowledgeable concerning Lyme disease and related

tick-borne illnesses.

(d)  Meetings.--

(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 Senate and 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:

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

professional information and education regarding Lyme disease

which shall include the broad spectrum of scientific and

treating options regarding all stages of Lyme disease and

related tick-borne illnesses.

(2)  Develop an active tick collection, testing and

surveillance program in cooperation with the Department of

Environmental Protection to provide a better understanding

of, including, but not limited to, the full range of tick-

borne diseases, geographic hot spots and levels of

infectivity to be used in targeting prevention and education

efforts. This effort may include veterinary data on tick-

borne disease prevention, specifically dogs and horses and

other animals as the Centers for Disease Control and

Prevention have recommended.

(3)  Cooperate with the Pennsylvania Game Commission to

disseminate the information required under paragraph (1) to

licensees of the Pennsylvania Game Commission and the general

public.

(4)  Cooperate with the Department of Conservation and

Natural Resources to disseminate the information required

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

State parks and lands.

(5)  Cooperate with the professional associations of

health care professionals to provide the education program

for professionals required under paragraph (1).

(6)  Cooperate with the Department of Education to:

(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

State officials.

(iii)  Update policies to recognize signs or symptoms

of Lyme disease and related tick-borne illnesses as

health conditions potentially requiring accommodations.

(7)  Cooperate with the Department of Environmental

Protection to publish and make available on its publicly

accessible Internet website the information developed under

paragraph (2) to health care professionals and the general

public.

(8)  Cooperate with The Pennsylvania State University,

Department of Entomology, Cooperative Extension Program for

Integrated Pest Management, to disseminate educational

resources about ticks, related diseases and integrated pest

management for disease prevention as required under paragraph

(1) to health care professionals and the general public.

(9)  Identify and apply for public and private funding in

order to carry out the provisions of this act.

Section 6.  Required coverage.

(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,

and it is documented in the patient's medical record 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.  Effective date.

This act shall take EFFECT July 1, 2013.