PRINTER'S NO. 656
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
100
Session of
2023
INTRODUCED BY BROOKS, DILLON, LANGERHOLC, KANE, STREET, J. WARD,
MASTRIANO, COSTA, L. WILLIAMS, REGAN AND COLLETT,
APRIL 27, 2023
REFERRED TO HEALTH AND HUMAN SERVICES, APRIL 27, 2023
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 the highest incidence of Lyme
disease in the country in 10 of the past 11 years. Each year,
approximately 100,000 Pennsylvanians get Lyme disease.
(2) In 2018, there were 102,080 confirmed and probable
Lyme disease cases reported in this Commonwealth, which
represents 30.32% of all cases in the United States. This is
an incidence rate of 70.3 per 100,000 confirmed and probable
cases in 2019.
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(3) From 2010 to 2019, there have been more than 66,144
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
estimated number of Lyme disease cases are 661,440 based on
the Centers for Disease Control and Prevention's 10 times
multiplier of actual cases. Therefore, with more than
12,960,000 Pennsylvanians in 2019, an estimated 5.1% of
Pennsylvanians contracted Lyme disease in the same 10 years.
(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 infected blacklegged
ticks are 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
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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.
(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
practitioners.
(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.
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(5) To promote the availability of diagnostic testing
and antibiotic therapies for patients by licensed health care
practitioners.
(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.
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive health care services under
a health insurance policy.
"Department." The Department of Health of the Commonwealth.
"Enrollee." An individual who is entitled to receive health
care services under an agreement with the Department of Human
Services.
"Government program." Either of the following:
(1) The medical assistance program established under the
act of June 13, 1967 (P.L.31, No.21), known as the Human
Services Code.
(2) The children's health insurance program established
under Article XXIII-A of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921.
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"Health care practitioner." As defined in section 103 of the
act of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Health insurance policy." An individual or group insurance
policy, subscriber contract, certificate or plan issued by an
insurer that provides medical or health care coverage, including
emergency services. The term does not include:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
(7) A fixed indemnity policy.
(8) A hospital indemnity policy.
(9) A dental only policy.
(10) A vision only policy.
(11) A workers' compensation policy.
(12) An automobile medical payment policy.
(13) A homeowners' insurance policy.
(14) A short-term limited duration policy.
(15) Any other similar policy providing for limited
benefits.
"Insurer." An entity licensed by the Insurance Department
with accident and health authority to issue a health insurance
policy that is offered or governed under any of the following:
(1) The Insurance Company Law of 1921, including section
630 and Article XXIV.
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(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to practitioner health services
plan corporations).
"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 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.
"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 practitioners for individual patient
diagnoses.
Section 5. Treatment.
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(a) Testing and therapy.--A health care practitioner may
order diagnostic testing and prescribe, administer or dispense
antibiotic therapy of the duration the licensed health care
practitioner 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
practitioner shall consult and report to the Statewide registry
under section 6(c) when making a clinical diagnosis.
Section 6. Duties of department.
(a) Comprehensive educational program.--The department shall
conduct an annual public information campaign to inform each
licensed physician, physician's assistant, certified registered
nurse and other health care practitioners 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.
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(2) Educational materials shall be available at no cost
and shall be developed for specific audiences, including
health care practitioners, 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 practitioners. 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 health care practitioner, information,
including diagnostic testing information and testing results,
confirmed or suspected diagnosis and surveillance criteria
applied to determine the confirmed or suspected diagnosis.
Section 7. Lyme Disease Testing Coverage.
(a) General rule.--A health insurance policy or government
program shall provide to covered persons or enrollees who are
seeking treatment in accordance with section 5 for Lyme disease
or related tick-borne illness the following coverage when
ordered by the covered person's or enrollee's health care
practitioner:
(1) All diagnostic testing. 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.
(3) The prescribed treatment for Lyme disease or related
tick-borne illnesses if the clinical diagnosis and treatment
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plan are documented in the covered person's or enrollee'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 covered person's or enrollee's attending health care
practitioner.
(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
health insurance policy or government 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) Report by insurers.--By January 1, 2025, an insurer
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. Application.
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 health insurance 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 health
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insurance policy offered, 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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