A03944
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1188
Session of
2022
INTRODUCED BY BROOKS, LANGERHOLC, COSTA, REGAN, MASTRIANO, KANE
AND J. WARD, APRIL 5, 2022
REFERRED TO HEALTH AND HUMAN SERVICES, APRIL 5, 2022
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. Legislative findings.
The General Assembly finds as follows:
(1) This Commonwealth has ranked the highest in the
country in the number of confirmed Lyme disease cases for the
past decade.
(2) In 2019, there were 6,763 confirmed and 2,235
probable Lyme disease cases reported in this Commonwealth,
according to data released by the Centers for Disease Control
and Prevention. This is an incidence rate of 52.8 in 2019 and
62.3 over three years.
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(3) From 2000 to 2021, there have been more than 110,000
confirmed Lyme disease cases in this Commonwealth, but due to
the fact that the Centers for Disease Control and
Prevention's number only represents confirmed cases, the
actual number of Lyme disease cases may be far greater. These
numbers continue to increase and Pennsylvania is categorized
as a "high incidence" area.
(4) In July 2021, the Department of Environmental
Protection, the Department of Conservation and Natural
Resources and the Physician General discussed the high
incidence in Pennsylvania resulting in high prevalence of
ticks and confirmed a high risk of Lyme disease in every
county of this Commonwealth. The Department of Environmental
Protection collected two times more blacklegged tick nymphs
in 2021 compared to 2020 and stated that the blacklegged tick
is present in all 67 counties in this Commonwealth.
(5) According to the Centers for Disease Control and
Prevention, Lyme disease is the most common vector-borne
disease in the United States.
(6) The early clinical diagnosis and appropriate
treatment of these tick-borne diseases and illnesses can
greatly reduce the risks of continued, diverse and chronic
symptoms that can affect every system and organ of the human
body and often every aspect of an individual's life.
(7) Between 10% to 40% of Lyme disease patients may go
on to suffer from complex, chronic/persistent conditions
which may be more difficult to treat.
(8) There are multiple diagnostic and treatment
guidelines for diagnosis and treatment of Lyme disease and
tick-borne illness.
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(9) Scientific understanding of these complex tick-borne
illnesses is expected to evolve rapidly in the next decade,
including prevention, diagnosis and treatment options.
(10) A 2013 Centers for Disease Control and Prevention
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.
(11) In 2014, the Massachusetts Center for Health and
Information Analysis found little to no increase in insurance
costs as a result of expanding coverage to include longer-
term courses of antibiotics. The expansion by fully insured
health plans was projected to result in an average annual
increase, over five years, to the typical member's monthly
health insurance premiums of between a negligible amount and
13¢ per year.
Section 3. Legislative purpose.
The purposes of this act are:
(1) To promote the education and awareness of Lyme and
other tick-borne diseases and illnesses among health care
professionals.
(2) To substantially reduce the incidence of tick-borne
diseases and illnesses by providing insurance coverage for
diagnostic testing and treatment.
(3) To eliminate, or at the very least, significantly
reduce the number of confirmed Lyme disease cases and related
tick-borne illnesses in this Commonwealth.
(4) To promote the availability of tick testing to aid
in determining a clinical diagnosis.
(5) To promote the availability of diagnostic testing
and antibiotic therapies for patients by licensed health care
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professionals.
(6) To improve public awareness of Lyme disease and
related tick-borne illnesses and educate the public about
tick bite prevention practices that can reduce the incidence
and prevalence of ticks in this Commonwealth.
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:
"Clinical diagnosis." A diagnosis of a patient based
primarily on information obtained from medical history, a
physical examination of the patient and review of medical
records, including laboratory tests and radiologic studies or
other differential diagnostic testing.
"Department." The Department of Health of the Commonwealth.
"Health care professional." A licensed physician,
physician's assistant, certified registered nurse practitioner
or other licensed health care professional.
"Lyme disease." 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, 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 such an infection as determined by a health
care professional.
"Related tick-borne illness." The presence of signs or
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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.
"Surveillance criteria." The set of case definition
standards established by the Centers for Disease Control and
Prevention for the purposes of consistency in research or for
evaluating trends in the spread of various diseases, but which
the Centers for Disease Control and Prevention does not intend
to be used by health care professionals for individual patient
diagnoses.
Section 5. Treatment.
(a) Testing and therapy.--A health care professional may
order diagnostic testing and prescribe, administer or dispense
antibiotic therapy of the duration the licensed health care
professional determines appropriate for the 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 illnesses and by documenting the
diagnosis and treatment in the patient's medical records.
(b) Report.--For the purpose of advancing tick-borne
diseases and illness research and documenting the incidence and
prevalence across Pennsylvania, the attending health care
professional shall consult and report to the Statewide registry
when making a clinical diagnosis.
Section 6. Duties of department.
(a) Comprehensive educational program.--The department shall
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conduct an annual public information campaign to inform each
licensed physician, physician's assistant, certified registered
nurse and other health care professionals of the requirements of
this act.
(b) Distribution of literature about Lyme disease and
related tick-borne illnesses.--The department shall provide
educational material in accordance with the following:
(1) The department shall provide culturally and
linguistically appropriate educational materials regarding
Lyme disease and related tick-borne illnesses, prevention of
disease and illness, treatment for disease and illness,
surveillance research and, when appropriate, the requirements
of this act.
(2) Educational materials shall be available at no cost
and shall be developed for specific audiences, including
health care professionals, patients and the general public.
(c) Statewide registry.--The department shall partner with
the Tick Research Lab of Pennsylvania at East Stroudsburg
University to develop an electronic database for use by the Tick
Research Lab, the department and health care professionals. The
database shall include the following nonidentifiable patient
information submitted to the department:
(1) From the Tick Research Lab of Pennsylvania, tick
testing information, including the results of the testing and
the zip code and county location of where the tick was
extracted.
(2) From the attending health care professional,
information, including diagnostic testing information and
testing results, confirmed or suspected patient diagnosis and
surveillance criteria applied to determine the confirmed or
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suspected patient diagnosis.
Section 7. Lyme Disease Testing Coverage.
(a) General rule.--A health insurance policy or government
program under this section shall provide to covered individuals
or recipients who are seeking treatment in accordance with
section 5 for Lyme disease or related tick-borne illness the
following coverage:
(1) All diagnostic testing ordered by the patient's
attending health care professional. This includes testing of
all bands on the western blot test for the purposes of a
clinical diagnosis and determining appropriate treatment.
(2) Tick testing when ordered by the patient's attending
health care professional.
(3) The prescribed treatment for Lyme disease or related
tick-borne illnesses if the clinical diagnosis and treatment
plan are documented in the patient's medical record.
Treatment plans may include short-term or long-term durations
of antibiotic or antimicrobial treatments, including both
oral or intravenous, as prescribed by the patient's attending
health care professional.
(4) Longer-term antibiotic treatment otherwise
ineligible 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.
(b) Copayments, deductibles and coinsurance.--Coverage under
this section shall be subject to copayment, deductible and
coinsurance provisions and any other general exclusions or
limitations of a health insurance policy or government program
to the same extent as other medical services covered by the
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policy or program are subject to these provisions.
(c) Construction.--This section does not limit benefits
which are otherwise available to an individual under a health
insurance policy or government program.
(d) Applicability.--This section shall apply as follows:
(1) This section shall apply to any health insurance
policy offered, issued or renewed on or after July 1, 2023,
in this Commonwealth to groups of 51 or more employees. This
section may not apply to any of the following policies:
(i) A hospital indemnity policy.
(ii) An accident-only policy.
(iii) A specified disease policy.
(iv) A long-term care or disability income policy.
(v) A credit-only policy.
(vi) A dental-only policy.
(vii) A vision-only policy.
(viii) A Medicare or supplement policy.
(ix) A federally funded plan, including TRICARE,
formerly CHAMPUS, covering military personnel and
dependents, Veterans Administration and the Federal
Employees Health Benefit Plan.
(x) Self-insured plans, subject to Federal law.
(xi) An automobile medical payment policy.
(xii) A fixed indemnity policy.
(xiii) Another similar policy providing for limited
benefits.
(2) This section shall apply to each contract executed
on or after July 1, 2023, by the adult basic coverage
insurance program established under Chapter 13 of the act of
June 26, 2001 (P.L.755, No.77), known as the Tobacco
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Settlement Act, under Article XXIII-A of the act of May 17,
1921 (P.L.682, No.284), known as The Insurance Company Law of
1921, or by any successor program.
(3) On January 1, 2025, insurers shall make a report to
the Insurance Department, in a form and manner as determined
by the department, to evaluate the implementation of this
section.
Section 8. Implementation.
Section 7 shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Insurance
Office, this act shall apply to any policy for which a form
or rate is first filed on or after the effective date of this
section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Insurance Office, this act shall apply to any policy issued
or renewed on or after 180 days after the effective date of
this section.
Section 9. Regulations.
The department shall promulgate rules and regulations to
administer and enforce this act.
Section 10. Effective date.
This act shall take effect in 60 days.
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