PRINTER'S NO. 123
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
100
Session of
2019
INTRODUCED BY BROOKS, SCAVELLO, REGAN, LANGERHOLC, ARGALL,
FONTANA, SCHWANK, BREWSTER, J. WARD, DINNIMAN, COSTA,
LAUGHLIN, ALLOWAY AND HAYWOOD, FEBRUARY 1, 2019
REFERRED TO BANKING AND INSURANCE, FEBRUARY 1, 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) Pennsylvania leads the nation in the number of
confirmed cases of Lyme disease. The number of Lyme disease
cases more than quintupled from year 2000 to 2016, jumping
from 2,271 cases to 11,443 cases, according to the Department
of Health. 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
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Pennsylvania in 2016 was closer to 114,430.
(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 that 67 counties had
the blacklegged tick. In 2016, scientists estimated one in
five ticks were infected with the bacteria that causes Lyme
disease in the Lehigh Valley alone.
(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 which
is much more difficult to treat.
(5) There are multiple diagnostic and treatment
guidelines for diagnosis and treatment of Lyme disease and
tick-borne illness.
(6) Scientific understanding of these complex tick-borne
illnesses is expected to evolve rapidly in the next decade,
including prevention, diagnosis and treatment options.
(7) The exercise of the patient's right of self-
determination is a cornerstone of medical ethics, endorsed by
the American Medical Association, American College of
Physicians and other professional medical organizations.
Patients should be fully informed of their options, taking
into account the best scientific evidence available,
especially in emerging diseases, and the physician's clinical
judgment and, in light of the patient's values and
preferences, patients should be informed in order to make the
best decision for themselves.
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(8) In 2014, the Massachusetts Center for Health and
Information Analysis (CHIA) 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 13ยข per year.
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:
"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.
"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
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care professional.
"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.
"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 4. Legislative intent.
It is the intent of the General Assembly to ensure that
patients have access to available and emerging diagnostics and
treatment options for Lyme disease and related tick-borne
illnesses as prescribed by attending health care professionals.
Section 5. Treatment.
A licensed 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.
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Section 6. Required coverage.
(a) Duty to provide.--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:
(1) Shall cover the prescribed treatment for Lyme
disease or related tick-borne illnesses if the 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, as
prescribed by the patient's attending health care
professional.
(2) Shall not deny coverage for longer-term antibiotic
treatment otherwise eligible 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) 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) Medicare and Medicare Advantage.
(8) Any federally funded plans, including TRICARE,
formerly CHAMPUS, covering military personnel and dependents,
Veterans Administration and the Federal Employees Health
Benefit Plan.
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(9) Self-insured plans, subject to Federal law.
(10) Other limited insurance benefit plans.
Section 7. Immunity.
(a) General rule.--No health care professional may be
subject to disciplinary action by the health care professional's
licensing board solely for diagnosing Lyme disease or related
tick-borne illnesses 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 related tick-borne illnesses, if the diagnosis,
treatment plan and ongoing monitoring has been documented in the
patient's medical record.
(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
professional 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 treatment relating to Lyme disease or
related tick-borne illnesses.
Section 8. Effective date.
This act shall take effect immediately.
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