Regular Session 2019-2020 House Bill 0629 P.N. 1353

PRIOR PRINTER'S NOS. 624, 1090

PRINTER'S NO. 1353

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

629

Session of

2019

INTRODUCED BY RAPP, KAUFFMAN, BOROWICZ, HERSHEY, OWLETT,

ZIMMERMAN, SAYLOR, REESE, ROTHMAN, GLEIM, STRUZZI, HARKINS,

MURT, STURLA, QUINN, READSHAW, T. DAVIS, JAMES, STAATS,

PEIFER, BARRAR, McNEILL, D. MILLER, JOZWIAK, FREEMAN, BOBACK,

MACKENZIE, OTTEN, DeLUCA, CAUSER, PICKETT, LAWRENCE,

B. MILLER, GILLEN, GABLER, MASSER, ECKER, RAVENSTAHL,

HANBIDGE, MILLARD, EVERETT, EMRICK, FRITZ, SAPPEY, F. KELLER,

HELM AND HENNESSEY, FEBRUARY 28, 2019

AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,

APRIL 9, 2019

AN ACT

Providing for patient access to diagnostics and treatments for

Lyme disease and related tick-borne illnesses; and requiring

health care policies to provide certain 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 Disease

and Related Tick-Borne Illness Diagnosis and Treatment Act.

Section 2. Findings.

The General Assembly finds as follows:

(1) From 1990 to 2017, Pennsylvania reported 116,824

confirmed cases of Lyme disease and in 2017 reported 11,900

new cases, ranking highest in the nation in confirmed cases

for the last seven years. Because the United States

Department of Health and Human Services Centers for Disease

Control and Prevention estimates cases may be underreported

by a factor of 10, it is estimated that the number of Lyme

disease cases in Pennsylvania in 2017 was closer to 119,000.

(2) In 2015, the Department of Environmental Protection

published a study that confirmed a high risk of Lyme disease

in every county of this Commonwealth and noted that 67

counties had the blacklegged tick.

(3) Early diagnosis and treatment of these tick-borne

illnesses 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.

(4) Between 10% to 40% of Lyme disease patients may go

on to suffer from a complex, chronic/persistent disease

CONDITIONS which is much MAY BE more difficult to treat.

(5) There are multiple diagnostic and treatment

guidelines for diagnosis and treatment of Lyme disease and

tick-borne illness.

(6) A 2013 Centers for Disease Control and Prevention

(CDC) study found that only 39% of individuals with Lyme

disease were treated using short-term antibiotics. The

majority of the individuals were treated for longer periods.

(7) Scientific understanding of these complex tick-borne

illnesses is expected to evolve rapidly in the next decade,

including diagnosis and treatment options.

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:

"Health care practitioner." A health care practitioner as

defined in section 103 of the act of July 19, 1979 (P.L.130,

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No.48), known as the Health Care Facilities Act, who is

authorized to prescribe medication in this Commonwealth.

"Health insurance policy."

(1) An individual or group health, sickness or accident

policy, or subscriber contract or certificate offered, issued

or renewed by an entity subject to one of the following:

(i) The act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921, including section

630 and Article XXIV of the act.

(ii) The act of December 29, 1972 (P.L.1701,

No.364), known as the Health Maintenance Organization

Act.

(iii) The provisions of 40 Pa.C.S. Ch. 61 (relating

to hospital plan corporations) or 63 (relating to

professional health services plan corporations).

(2) The term does not include accident only, fixed

indemnity, limited benefit, credit, dental, vision, specified

disease, Medicare supplement, Civilian Health and Medical

Program of the Uniformed Services (CHAMPUS) supplement, long-

term care or disability income, workers' compensation or

automobile medical payment insurance.

"Lyme disease." Signs or symptoms compatible with acute,

late-stage, persistent infection with Borrelia burgdorferi or

complications related to the infection or with other strains of

Borrelia, including, but not limited to, B. miyamotoi, B.

mayonii, B. garinii and B. afzelii, 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 the

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infection as determined by a health care practitioner.

"Related tick-borne illness." The presence of signs or

symptoms compatible with infection with bartonella,

babesiosis/piroplasmosis, anaplasmosis, ehrlichiosis, Rocky

Mountain spotted fever, rickettsiosis or other tick-

transmissible illness or complications related to the

infections. The term does not include Lyme disease.

Section 4. Treatment.

(A) OPTIONS.--A health care practitioner may order

diagnostic testing and prescribe, administer or dispense

antibiotic therapy for the duration the health care practitioner

determines appropriate for a patient, for the therapeutic

purpose of eliminating or controlling a patient's infection or

symptoms, upon making a clinical diagnosis that the patient has

Lyme disease or a related tick-borne illness or displays

symptoms consistent with a clinical diagnosis of Lyme disease or

related tick-borne illness. The health care practitioner must

document the diagnosis and treatment in the patient's medical

records.

(B) REQUIRED DISCLOSURE.--A HEALTH CARE PRACTITIONER SHALL

FULLY DISCLOSE ALL RISKS AND BENEFITS ASSOCIATED WITH ANY

RECOMMENDED TREATMENT OPTION. THE DISCLOSURE SHALL INCLUDE

ALTERNATIVES THAT A REASONABLE PRUDENT PATIENT WOULD REQUIRE TO

MAKE AN INFORMED DECISION. THE DISCLOSURE OF THE INFORMATION

UNDER THIS SUBSECTION SHALL BE RECORDED IN THE PATIENT'S MEDICAL

RECORD.

Section 5. Coverage requirement.

The following apply:

(1) Every health insurance policy which is delivered,

issued for delivery, renewed, extended or modified in this

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Commonwealth shall cover the prescribed treatment for Lyme

disease and related tick-borne illnesses if the diagnosis and

treatment plan are documented in the patient's medical

record. Treatment plans may include short or longer durations

of antibiotic or antimicrobial treatments, as prescribed by

the patient's attending health care practitioner.

(2) Coverage of longer-term antibiotic treatment may not

be denied solely because the treatment may be characterized

as unproven, experimental or investigational in nature for

the treatment of Lyme disease and related tick-borne

illnesses. PROVIDE COVERAGE FOR LONG-TERM ANTIBIOTIC AND

ANTIMICROBIAL THERAPY FOR A PATIENT WITH LYME DISEASE AND

RELATED TICK-BORNE ILLNESSES WHEN DETERMINED BY A HEALTH CARE

PRACTITIONER TO BE MEDICALLY NECESSARY AND ORDERED BY A

HEALTH CARE PRACTITIONER AFTER MAKING A THOROUGH EVALUATION

OF THE PATIENT'S SYMPTOMS, DIAGNOSTIC TEST RESULTS OR

RESPONSE TO TREATMENT.

(2) NOTHING IN THIS SECTION SHALL BE CONSTRUED AS

LIMITING A HEALTH INSURER'S ABILITY TO USE UTILIZATION

MANAGEMENT TOOLS.

Section 6. Immunity LICENSING AUTHORITY.

(a) General rule.--No health care practitioner shall be

subject to disciplinary action by the health care

practitioner's licensing board solely for diagnosing Lyme

disease or a related tick-borne illness, or for prescribing,

administering or dispensing longer-term antibiotic therapies for

the therapeutic purpose of eliminating infection or controlling

a patient's symptoms when the patient is clinically diagnosed

with Lyme disease or a related tick-borne illness if the

diagnosis, treatment plan and ongoing monitoring has been

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documented in the patient's medical record. AND RECOMMENDING A

TREATMENT PROTOCOL WHICH THE HEALTH CARE PRACTITIONER DEEMS

MEDICALLY NECESSARY BASED ON THE PATIENT'S NEEDS AND RESPONSES

TO OTHER CLINICAL MEASURES.

(b) Construction.--Nothing in this section shall be

construed to deny the right of a licensing board to deny, revoke

or suspend the license of or to discipline any health care

practitioner who:

(1) prescribes, administers or dispenses longer-term

antibiotic therapy for a nontherapeutic purpose;

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

longer-term antibiotics; or

(3) fails to keep complete and accurate records of the

diagnosis, treatment and response to treatment of a patient

receiving longer-term antibiotic treatment relating to Lyme

disease or a related tick-borne illness.

Section 7. Applicability.

(a) Health insurance policies.--This act shall apply to

health insurance policies as follows:

(1) For a health insurance policy for which either rates

or forms are required to be filed with the Federal Government

or the Insurance Department, this act shall apply to any

policy for which a form or rate is first filed on or after

180 days after the date of enactment of this act.

(2) For a health insurance policy for which neither

rates nor forms are required to be filed with the Federal

Government or the Insurance Department, this act shall apply

to any policy issued or renewed on or after 180 days after

the date of enactment of this act.

(b) Contracts.--This act shall apply to contracts between

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health care practitioners and insurers that are executed or

renewed on or after 180 days after the date of enactment of this

act.

Section 8. Effective date.

This act shall take effect in 180 60 days.

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