THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY GREENLEAF, ARGALL, TARTAGLIONE, BROWNE, RAFFERTY, ERICKSON, COSTA, WAUGH, FONTANA, BOSCOLA, SMUCKER, PICCOLA, BAKER, McILHINNEY, DINNIMAN, FARNESE, BLAKE AND KASUNIC, JANUARY 31, 2011

SENATOR D. WHITE, BANKING AND INSURANCE, AS AMENDED, MARCH 7, 2012   

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 to

execute prevention and education strategies and ensure

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patient access to appropriate care and treatment.

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 Education, Prevention and Treatment

Act.

Section 2.  Findings.

The General Assembly finds that:

(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 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.

(4)  Lyme disease is most prevalent in Southeastern

Pennsylvania, but it is found across this Commonwealth.

(5)  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.

(6)  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.

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

signs and symptoms which can become quite severe.

(8)  Because of differences in the rate of progress of

the disease and in individual responses to the disease and

treatment, some patients may have signs and symptoms for

months or years.

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)  Physicians, certified registered nurse

practitioners, insurers, patients and governmental

agencies are educated that multiple standards of care

exist.

(ii)  Physicians and other medical professionals

provide patients with sufficient information about all

standards of care to enable patients to make an informed

choice as part of informed consent and respect the

autonomy of that choice.

(iii)  Physicians have the right to exercise their

clinical judgment in diagnosing and treating their

patients and in applying short-term or long-term

antibiotic therapies for a therapeutic purpose to

eliminate infection or to control a patient's symptoms as

reflected in the patient's medical record.

(iv)  Insurance reimbursement be provided for

treatment rendered in accordance with the standard of

care chosen.

(v)  Pennsylvania government agencies provide

unbiased information regarding multiple standards of

care.

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 State Board of Medicine or the State Board of

Osteopathic Medicine.

"CDC surveillance case definitions."  Definitions that

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 insurance reimbursement.

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

"Licensee."  A licensed physician or doctor of osteopathy or

a 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 the presence in a

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 CDC

surveillance case definitions. It also includes other acute and

chronic manifestations as clinically determined by the treating

physician.

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

babesiosis/piroplasmosis, anaplasmosis, ehrlichiosis and other

tick-transmissible illnesses.  The terms do not include Lyme

disease.

"Standard of care."  Short-term or long-term antibiotic

therapies prescribed by a licensed physician to a patient for a

therapeutic purpose to eliminate infection or to control a

patient's symptoms, provided the clinical diagnosis and

treatment are documented in the patient's medical record by the

licensed physician.

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

patient's symptoms or signs determined by the treating physician

as reasonably related to Lyme disease and 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 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)  Development of a program of general public and

medical 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 multiple standards of care

available 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 Education to:

(i)  Disseminate the information required under

paragraph (3) to school administrators, 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 chronic Lyme

disease and related tick-borne illnesses as health

conditions 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 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 licensed in this Commonwealth who are

knowledgeable concerning treatment of early and late stage

chronic or persistent Lyme disease and who are members of the

International Lyme and Associated Diseases Society.

(7)  An epidemiologist licensed in this Commonwealth who

has expertise in spirochetes and related infectious diseases.

(8)  Two individuals who represent Lyme disease patient

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

of a Lyme disease patient.

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

family member of a Lyme disease patient.

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

after all appointments have been made and shall meet at least

quarterly.

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

force shall receive no compensation for their services but shall

be allowed their actual and necessary expenses incurred in

performance of their duties. Reimbursement shall be provided by

the department.

(f)  Department.--The department shall have the following

powers and duties:

(1)  Develop a program of general public 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)  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.

(3)  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.

(4)  Cooperate with the Department of Education to:

(i)  Disseminate the information required under

paragraph (1) to school administrators, 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 chronic Lyme

disease and related tick-borne illnesses as health

conditions potentially requiring accommodations.

(5)  Cooperate with the professional associations of

health care professionals to provide the education program

for professionals required under paragraph (1).

Section 6.  Required coverage.

(a)  General rule.--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 and related tick-borne illness rendered in accordance

with the standard of care and documented in the physician's

medical record for that patient and with the informed choice and

consent of the patient.

(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.  Licensee's right to diagnose and treat lyme disease

and related tick-borne illnesses.

(a)  Rights included.--

(1)  A licensee may prescribe, administer or dispense

antibiotic or antimicrobial therapy for therapeutic purposes

to a person diagnosed with and having symptoms or signs of

Lyme disease or related tick-borne illnesses if the diagnosis

and standard of care have been documented in the licensee's

medical record for that patient.

(2)  No licensee shall be subject to professional

misconduct proceedings or to disciplinary action by the board

solely for prescribing, administering or dispensing long-term

antibiotic or antimicrobial therapy for a therapeutic purpose

for a patient clinically diagnosed with Lyme disease or

related tick-borne illnesses if the diagnosis and standard of

care have been documented in the licensee's medical record

for that patient.

(b)  Denial, revocation or suspension of license or

discipline of licensee.--Nothing in this section shall diminish

the right of the board to deny, revoke or suspend the license of

a licensee or discipline a licensee who:

(1)  prescribes, administers or dispenses long-term

antibiotic or antimicrobial therapy for a nontherapeutic

purpose;

(2)  fails to monitor the ongoing care of a patient

receiving long-term antibiotic or antimicrobial therapy; or

(3)  fails to keep complete and accurate ongoing records

of the diagnosis and treatment of a patient receiving long-

term antibiotic or antimicrobial therapy.

Section 8.  Professional misconduct proceedings.

(a)  General rule.--Whenever the board initiates, or has

initiated, investigations or professional misconduct proceedings

against a licensee as a result of a complaint filed by an

insurance company, pharmacy benefit manager or comprehensive

health services plan under this act, which in whole or in part

concerns the licensee's diagnosis or treatment of Lyme disease

or a related tick-borne illness, a copy of the complaint shall

be provided to the licensee within ten days after the licensee's

request.

(b)  Requirements of charges.--Whenever charges are made

which, in whole or in part, concern a licensee's diagnosis or

treatment of Lyme disease or a related tick-borne illness, the

charges shall contain a statement of facts sufficient to allow a

judicial determination as to whether the charges are proper

under this section.

(c)  Notice of hearing.--Whenever a notice of hearing is

served in which the charges or allegations against the licensee,

in whole or in part, concern the licensee's diagnosis or

treatment of Lyme disease or a related tick-borne illness or the

administration of long-term antibiotic or antimicrobial therapy

or concern any patient who has been diagnosed with Lyme disease

or a related tick-borne illness, the notice shall contain the

identity of any expert consulted by the board or to be called to

testify by the board and the substance of the opinion of the

expert.

Section 9.  Applicability.

This act shall apply to proceedings pending on or after the

effective date of this section.

Section 10.  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 that:

(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 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

2010, provisional numbers of 6,277 cases, confirm this

ongoing upward trend.

(4)  These trends illustrate the World Health

Organization's (WHO) projections through 2100. 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

to 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:

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

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

certified registered nurse practitioner or other licensed health

care professional.

"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 that meets the surveillance criteria

established 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 illness."  A case of Bartonella,

babesiosis/piroplasmosis, anaplasmosis, ehrlichiosis or other

tick-transmissible illness. The term does not include Lyme

disease.

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

"State officials."  The term includes the Secretary of

Environmental Protection of the Commonwealth.

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

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)  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 Education to:

(i)  Disseminate the information required under

paragraph (3) to school administrators, 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)  Cooperation of the Department of Environmental

Protection to test ticks and provide results and to publish

infection rates on its publicly accessible Internet website.

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

following individuals: 

(1)  The secretary or a designee.

(2)  The Secretary of the Commonwealth 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 licensed in this Commonwealth who are

knowledgeable concerning treatment of Lyme disease and

related tick-borne illness 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 illness and who are members of the

Infectious Diseases Society of America.

(8)  An epidemiologist licensed in this Commonwealth who

has expertise in spirochetes and related infectious diseases.

(9)  Two individuals who represent Lyme disease patient

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

of a Lyme disease patient.

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

family member of a Lyme disease patient.

(11)  Two registered nurses licensed in this

Commonwealth, one of whom is a certified registered nurse

practitioner and both of whom are knowledgeable concerning

Lyme disease and related tick-borne illness.

(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

related tick-borne illness.

(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 illness.

(d)  Meetings.--

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

section, the secretary shall appoint the members of the task

force. The secretary shall appoint a chairman of the task

force.

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

effective date of this section and shall meet at least

quarterly.

(3)  The task force shall issue a report with

recommendations to the secretary within one year of its first

meeting. The report shall also be transmitted to the Public

Health and Welfare Committee of the Senate and the Health

Committee of the House of Representatives.

(4)  Nothing in this act shall be construed to prohibit

the task force from making interim reports.

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

force shall receive no compensation for their services but shall

be allowed their actual and necessary expenses incurred in

performance of their duties. Reimbursement shall be provided by

the department.

(f)  Duties of department.--The department shall:

(1)  Develop a program of general public 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 intensive program including active

population-based surveillance, active tick surveillance and

sentinel (nonhuman) data to provide a better understanding

of, including, but not limited to, 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 Department of Education to:

(i)  Disseminate the information required 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.

(6)  Cooperate with professional associations of health

care professionals to provide the education program for

professionals required under paragraph (1).

(7)  Cooperate with the Department of Environmental

Protection to disseminate tick infection information required

under paragraph (1) 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.

Section 6.  Effective date.

This act shall take effect immediately.