PRINTER'S NO.  320

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

SENATE BILL

 

No.

210

Session of

2011

  

  

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

  

  

REFERRED TO BANKING AND INSURANCE, JANUARY 31, 2011  

  

  

  

AN ACT

  

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Establishing a task force on Lyme disease and related maladies;

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

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Department of Health, the Department of Conservation and

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Natural Resources and the Pennsylvania Game Commission to

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execute prevention and education strategies and ensure

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patient access to appropriate care and treatment.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  Short title.

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

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Related Tick-Borne Disease Education, Prevention and Treatment

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Act.

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Section 2.  Findings.

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The General Assembly finds that:

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

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carried primarily by ticks and pose a serious threat to the

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health and quality of life of many citizens of this

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Commonwealth.

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

 


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bitten by a tick that carries the spirochete.

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(3)  In 2009, 5,722 cases of Lyme disease were reported

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in this Commonwealth, the highest number of cases reported in

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any state, and representing a 76% increase since 2006.

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(4)  Lyme disease is most prevalent in Southeastern

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Pennsylvania, but it is found across this Commonwealth.

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(5)  With proper precautions taken while engaged in

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outdoor activities, people can greatly reduce their chances

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of tick pathogen transmission by making sure that frequent

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tick checks are made and ticks are removed and disposed of

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promptly and properly.

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(6)  The early clinical diagnosis and appropriate

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treatment of these tick-borne disorders and diseases can

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greatly reduce the risks of continued, diverse and chronic

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signs and symptoms which can affect every system and organ of

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the human body and often every aspect of life.

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

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signs and symptoms which can become quite severe.

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

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the disease and in individual responses to the disease and

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treatment, some patients may have signs and symptoms for

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months or years.

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Section 3.  Legislative intent.

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It is the intent of the General Assembly:

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(1)  To provide the public with information and education

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to create greater public awareness of the dangers of and

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measures available to prevent, diagnose and treat Lyme

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disease and related maladies.

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(2)  To ensure that:

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(i)  Physicians, certified registered nurse

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practitioners, insurers, patients and governmental

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agencies are educated that multiple standards of care

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exist.

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(ii)  Physicians and other medical professionals

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provide patients with sufficient information about all

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standards of care to enable patients to make an informed

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choice as part of informed consent and respect the

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autonomy of that choice.

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(iii)  Physicians have the right to exercise their

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clinical judgment in diagnosing and treating their

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patients and in applying short-term or long-term

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antibiotic therapies for a therapeutic purpose to

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eliminate infection or to control a patient's symptoms as

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reflected in the patient's medical record.

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(iv)  Insurance reimbursement be provided for

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treatment rendered in accordance with the standard of

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care chosen.

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(v)  Pennsylvania government agencies provide

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unbiased information regarding multiple standards of

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care.

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Section 4.  Definitions.

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The following words and phrases when used in this act shall

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have the meanings given to them in this section unless the

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context clearly indicates otherwise:

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"Board."  The State Board of Medicine or the State Board of

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Osteopathic Medicine.

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"CDC surveillance case definitions."  Definitions that

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establish uniform criteria for disease reporting and should not

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be used as the sole criteria for establishing clinical

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diagnoses, determining the standard of care necessary for a

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particular patient, setting guidelines for quality assurance or

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providing standards for insurance reimbursement.

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

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

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a certified registered nurse practitioner.

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"Long-term antibiotic or antimicrobial therapy."

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Administration of oral, intramuscular or intravenous antibiotics

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or antimicrobial medications, singly or in combination, for

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periods of more than four weeks.

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

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patient of signs and symptoms compatible with acute infection

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with Borrelia burgdorferi or related Borrelioses, or with the

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signs and symptoms of late stage or chronic infection with

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Borrelia burgdorferi, or with complications related to such an

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infection. The term includes infection which meets the CDC

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surveillance case definitions. It also includes other acute and

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chronic manifestations as clinically determined by the treating

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physician.

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

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babesiosis/piroplasmosis, anaplasmosis, ehrlichiosis and other

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tick-transmissible illnesses.  The terms do not include Lyme

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disease.

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

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therapies prescribed by a licensed physician to a patient for a

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therapeutic purpose to eliminate infection or to control a

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patient's symptoms, provided the clinical diagnosis and

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

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licensed physician.

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

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patient's symptoms or signs determined by the treating physician

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as reasonably related to Lyme disease and related tick-borne

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illnesses.

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Section 5.  Task force.

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

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force on Lyme disease and related tick-borne diseases.

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

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recommendations to the department regarding:

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(1)  The prevention of Lyme disease and related tick-

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borne illnesses in this Commonwealth.

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

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misdiagnosis of Lyme disease.

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(3)  Development of a program of general public and

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medical professional information and education regarding Lyme

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disease which shall include the broad spectrum of scientific

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and treatment views regarding Lyme disease and related tick-

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borne illnesses, including multiple standards of care

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available for all stages of Lyme disease and related tick-

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borne illnesses.

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(4)  Cooperation with the Pennsylvania Game Commission to

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disseminate the information required under paragraph (3) to

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licensees of the commission and the general public.

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(5)  Cooperation with the Department of Conservation and

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Natural Resources to disseminate the information required

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

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State parks and lands.

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(6)  Cooperation with the Department of Education to:

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(i)  Disseminate the information required under

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paragraph (3) to school administrators, faculty and

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staff, parents, guardians and students.

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(ii)  Determine what role schools may play in the

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prevention of Lyme disease, including, but not limited

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to, prompt removal and reporting of tick removals to

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State officials. 

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(iii)  Update policies to recognize chronic Lyme

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disease and related tick-borne illnesses as health

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conditions potentially requiring accommodations.

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

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following individuals:

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(1)  The Secretary of Health or a designee.

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(2)  The Insurance Commissioner or a designee.

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(3)  The Secretary of Education or a designee.

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(4)  The Deputy Secretary for Conservation and

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Engineering Services in the Department of Conservation and

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Natural Resources or a designee.

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(5)  The Director of the Bureau of Information and

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Education of the Pennsylvania Game Commission or a designee.

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(6)  Two physicians licensed in this Commonwealth who are

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knowledgeable concerning treatment of early and late stage

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chronic or persistent Lyme disease and who are members of the

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International Lyme and Associated Diseases Society.

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(7)  An epidemiologist licensed in this Commonwealth who

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has expertise in spirochetes and related infectious diseases.

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(8)  Two individuals who represent Lyme disease patient

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

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of a Lyme disease patient.

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

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family member of a Lyme disease patient.

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(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

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quarterly.

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

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force shall receive no compensation for their services but shall

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be allowed their actual and necessary expenses incurred in

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performance of their duties. Reimbursement shall be provided by

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the department.

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

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powers and duties:

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(1)  Develop a program of general public information and

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education regarding Lyme disease which shall include the

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broad spectrum of scientific and treating views regarding

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Lyme disease and related tick-borne illnesses, including

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multiple standards of care available for all stages of Lyme

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disease and related tick-borne illnesses.

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(2)  Cooperate with the Pennsylvania Game Commission to

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disseminate the information required under paragraph (1) to

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licensees of the Pennsylvania Game Commission and the general

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public.

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(3)  Cooperate with the Department of Conservation and

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Natural Resources to disseminate the information required

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

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State parks and lands.

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(4)  Cooperate with the Department of Education to:

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(i)  Disseminate the information required under

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paragraph (1) to school administrators, faculty and

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staff, parents, guardians and students.

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(ii)  Determine what role schools may play in the

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prevention of Lyme disease, including, but not limited

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to, prompt removal and reporting of tick removals to

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State officials. 

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(iii)  Update policies to recognize chronic Lyme

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disease and related tick-borne illnesses as health

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conditions potentially requiring accommodations.

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(5)  Cooperate with the professional associations of

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health care professionals to provide the education program

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for professionals required under paragraph (1).

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Section 6.  Required coverage.

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(a)  General rule.--Except as provided in subsection (b),

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every health care policy which is delivered, issued for

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delivery, renewed, extended or modified in this Commonwealth by

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a health insurer must cover prescribed treatment for Lyme

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disease and related tick-borne illness rendered in accordance

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

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medical record for that patient and with the informed choice and

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consent of the patient. 

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

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following types of insurance:

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(1)  Hospital indemnity.

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(2)  Accident.

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(3)  Specified disease.

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(4)  Disability income.

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(5)  Dental.

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(6)  Vision.

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(7)  Civilian Health and Medical Program of the Uniformed

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Services (CHAMPUS) supplement.

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(8)  Medicare supplement.

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(9)  Long-term care.

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(10)  Other limited insurance benefit plans.

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Section 7.  Licensee's right to diagnose and treat lyme disease

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and related tick-borne illnesses.

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(a)  Rights included.--

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(1)  A licensee may prescribe, administer or dispense

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antibiotic or antimicrobial therapy for therapeutic purposes

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to a person diagnosed with and having symptoms or signs of

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Lyme disease or related tick-borne illnesses if the diagnosis

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

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medical record for that patient.

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(2)  No licensee shall be subject to professional

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misconduct proceedings or to disciplinary action by the board

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solely for prescribing, administering or dispensing long-term

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antibiotic or antimicrobial therapy for a therapeutic purpose

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for a patient clinically diagnosed with Lyme disease or

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related tick-borne illnesses if the diagnosis and standard of

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care have been documented in the licensee's medical record

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for that patient.

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(b)  Denial, revocation or suspension of license or

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

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

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a licensee or discipline a licensee who:

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(1)  prescribes, administers or dispenses long-term

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antibiotic or antimicrobial therapy for a nontherapeutic

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purpose;

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

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receiving long-term antibiotic or antimicrobial therapy; or

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(3)  fails to keep complete and accurate ongoing records

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of the diagnosis and treatment of a patient receiving long-

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term antibiotic or antimicrobial therapy.

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Section 8.  Professional misconduct proceedings.

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

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initiated, investigations or professional misconduct proceedings

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

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insurance company, pharmacy benefit manager or comprehensive

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

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concerns the licensee's diagnosis or treatment of Lyme disease

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

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

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request.

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

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

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

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charges shall contain a statement of facts sufficient to allow a

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judicial determination as to whether the charges are proper

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under this section.

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

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served in which the charges or allegations against the licensee,

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

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

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administration of long-term antibiotic or antimicrobial therapy

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or concern any patient who has been diagnosed with Lyme disease

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

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

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

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expert.

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Section 9.  Applicability.

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This act shall apply to proceedings pending on or after the

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effective date of this section.

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Section 10.  Effective date.

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This act shall take effect immediately.

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