PRINTER'S NO. 1020
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
100
Session of
2021
INTRODUCED BY BROOKS, MASTRIANO, LANGERHOLC, COLLETT,
SANTARSIERO, J. WARD, CAPPELLETTI, AUMENT, BAKER, REGAN,
K. WARD, BOSCOLA, KANE AND HAYWOOD, AUGUST 11, 2021
REFERRED TO BANKING AND INSURANCE, AUGUST 11, 2021
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) This Commonwealth has ranked the highest in the
country in the number of confirmed Lyme disease cases for the
past eight years.
(2) In 2018, there were 10,208 Lyme disease cases
reported in this Commonwealth, but the Centers for Disease
Control and Prevention estimate under-reporting by a factor
of 10 and project occurrence rates, more accurately, in the
100,000s.
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(3) From 2000 to 2018, there were 106,718 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, possibly over 1 million.
(4) 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.
(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.
(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.
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(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
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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