HB 1013

1	A bill to be entitled
2	An act relating to Lyme disease; providing a short title;
3	creating s. 381.801, F.S.; providing definitions;
4	requiring certain health insurance policies and health
5	maintenance organization contracts to provide coverage for
6	Lyme disease diagnosis and treatment; creating s.
7	627.64194, F.S.; providing definitions; requiring certain
8	health insurance policies to provide coverage for Lyme
9	disease diagnosis and treatment; providing applicability
10	for referrals made in accordance with procedures
11	authorized by health insurance policies; amending s.
12	641.31, F.S.; providing definitions; requiring certain
13	health maintenance organization contracts to provide
14	coverage for Lyme disease diagnosis and treatment;
15	providing applicability for referrals made in accordance
16	with procedures authorized by health maintenance
17	organization contracts; providing an effective date.
18
19	WHEREAS, the Legislature recognizes that Lyme disease
20	exists in Florida and has a negative impact on its citizens, and
21	WHEREAS, Lyme disease is the most common vector-borne
22	disease in the United States and other tick-associated diseases
23	are being identified, and
24	WHEREAS, the Department of Health maintains that early
25	diagnosis and proper treatment of Lyme disease are important
26	strategies in avoiding the complications and expenses of
27	infection and late-stage illness, and
28	WHEREAS, the lack of insurance coverage for diagnosis and
29	long-term antibiotic therapies or other newly developed
30	evidence-based therapies or treatment is a major barrier to
31	adequate medical care for patients with symptoms compatible with
32	chronic Lyme disease, and
33	WHEREAS, the Legislature feels a responsibility to help the
34	citizens of the state who suffer from Lyme disease and who may
35	not obtain a timely diagnosis or obtain the appropriate
36	treatment, and to protect the physicians who treat sufferers of
37	Lyme disease, by adopting legislation that promotes the
38	diagnosis and treatment of Lyme disease in Florida, NOW,
39	THEREFORE,
40
41	Be It Enacted by the Legislature of the State of Florida:
42
43	Section 1.  This act may be cited as the "Lyme Disease
44	Insurance Coverage Act."
45	Section 2.  Section 381.801, Florida Statutes, is created
46	to read:
47	381.801  Lyme disease; definitions; coverage.--
48	(1)  For purposes of this section:
49	(a)  "Coverage" means an insurer may not contest, reverse,
50	or deny payment for diagnostic testing or long-term antibiotic
51	therapy or other newly developed evidence-based therapy based
52	upon a physician's order, whether the physician is in a
53	preferred provider network as defined in s. 627.6471(1)(c) or
54	not, if the treating physician has determined the therapy to be
55	medically necessary.
56	(b)  "Long-term antibiotic therapy" means administration of
57	oral, intramuscular, or intravenous antibiotics, singly or in
58	combination, for a period of more than 4 weeks.
59	(c)  "Lyme disease" means the clinical diagnosis by a
60	physician of the presence in a patient of signs and symptoms
61	compatible with acute, late-stage, recurrent, or chronic
62	infection with Borrelia burgdorferi or with complications
63	related to such an infection. Lyme disease includes an infection
64	that meets the surveillance criteria set forth by the Centers
65	for Disease Control and Prevention and also includes other
66	acute, late-stage, recurrent, and chronic manifestations of such
67	an infection as determined by the treating physician.
68	(d)  "Medically necessary" means the use of long-term
69	antibiotic therapy or other newly developed evidence-based
70	therapy that the physician has determined is necessary in a
71	particular case based on the patient's symptoms, signs, and
72	responsiveness to the treatment prescribed by the physician.
73	(e)  "Physician" means a person licensed to practice
74	medicine under chapter 458 or osteopathic medicine under chapter
75	459 or a person who is licensed to practice medicine or
76	osteopathic medicine in any other state and whose license is
77	currently valid and the requirements for practicing in such a
78	capacity are substantially similar to or are more stringent than
79	those of this state.
80	(2)  Health insurance policies and health maintenance
81	organization contracts shall provide coverage for the diagnosis
82	and treatment of Lyme disease, including long-term antibiotic
83	therapy or other newly developed evidence-based therapy, as
84	deemed to be medically necessary by a physician, as specified in
85	ss. 627.64194 and 641.31(36).
86	Section 3.  Section 627.64194, Florida Statutes, is created
87	to read:
88	627.64194  Required coverage for Lyme disease.--
89	(1)  As used in this section:
90	(a)  "Coverage" means an insurer may not contest, reverse,
91	or deny payment for diagnostic testing or long-term antibiotic
92	therapy or other newly developed evidence-based therapy based
93	upon a physician's order, whether the physician is in a
94	preferred provider network as defined in s. 627.6471(1)(c) or
95	not, if the treating physician has determined the therapy to be
96	medically necessary.
97	(b)  "Long-term antibiotic therapy" means administration of
98	oral, intramuscular, or intravenous antibiotics, singly or in
99	combination, for a period of more than 4 weeks.
100	(c)  "Lyme disease" means the clinical diagnosis by a
101	physician of the presence in a patient of signs and symptoms
102	compatible with acute, late-stage, recurrent, or chronic
103	infection with Borrelia burgdorferi or with complications
104	related to such an infection. Lyme disease includes an infection
105	that meets the surveillance criteria set forth by the Centers
106	for Disease Control and Prevention and also includes other
107	acute, late-stage, recurrent, and chronic manifestations of such
108	an infection as determined by the treating physician.
109	(d)  "Medically necessary" means the use of long-term
110	antibiotic therapy or other newly developed evidence-based
111	therapy that the physician has determined is necessary in a
112	particular case based on the patient's symptoms, signs, and
113	responsiveness to the treatment prescribed by the physician.
114	(e)  "Physician" means a person licensed to practice
115	medicine under chapter 458 or osteopathic medicine under chapter
116	459 or a person who is licensed to practice medicine or
117	osteopathic medicine in any other state and whose license is
118	currently valid and the requirements for practicing in such a
119	capacity are substantially similar to or are more stringent than
120	those of this state.
121	(2)  A health insurance policy that covers a resident of
122	this state and that is issued, amended, delivered, or renewed in
123	this state on or after July 1, 2006, shall provide coverage for
124	the diagnosis and treatment of Lyme disease and its sequelae,
125	including, but not limited to, long-term antibiotic therapy or
126	other newly developed evidence-based therapy to control Lyme
127	disease and its sequelae, when a physician deems the treatment
128	to be medically necessary and orders such therapy after making a
129	thorough evaluation of the patient's symptoms and signs,
130	diagnostic test results, and response to treatment and the
131	physician has documented objective clinical change.
132	(3)  This section shall apply to a physician who is
133	licensed to practice medicine or osteopathic medicine in any
134	other state and whose license is currently valid and the
135	requirements for practicing in such a capacity are substantially
136	similar to or are more stringent than those of this state,
137	provided a referral for the required coverage is made in
138	accordance with the procedures authorized by the health
139	insurance policy.
140	Section 4.  Subsections (36) through (40) of section
141	641.31, Florida Statutes, are renumbered as subsections (37)
142	through (41), respectively, and a new subsection (36) is added
143	to that section to read:
144	641.31  Health maintenance contracts.--
145	(36)(a)  As used in this subsection:
146	1.  "Coverage" means an insurer may not contest, reverse,
147	or deny payment for diagnostic testing or long-term antibiotic
148	therapy or other newly developed evidence-based therapy based
149	upon a physician's order, whether the physician is in a health
150	maintenance organization's provider network or not, if the
151	treating physician has determined the therapy to be medically
152	necessary.
153	2.  "Long-term antibiotic therapy" means administration of
154	oral, intramuscular, or intravenous antibiotics, singly or in
155	combination, for a period of more than 4 weeks.
156	3.  "Lyme disease" means the clinical diagnosis by a
157	physician of the presence in a patient of signs and symptoms
158	compatible with acute, late-stage, recurrent, or chronic
159	infection with Borrelia burgdorferi or with complications
160	related to such an infection. Lyme disease includes an infection
161	that meets the surveillance criteria set forth by the Centers
162	for Disease Control and Prevention and also includes other
163	acute, late-stage, recurrent, and chronic manifestations of such
164	an infection as determined by the treating physician.
165	4.  "Medically necessary" means the use of long-term
166	antibiotic therapy or other newly developed evidence-based
167	therapy that the physician has determined is necessary in a
168	particular case based on the patient's symptoms, signs, and
169	responsiveness to the treatment prescribed by the physician.
170	5.  "Physician" means a person licensed to practice
171	medicine under chapter 458 or osteopathic medicine under chapter
172	459 or a person who is licensed to practice medicine or
173	osteopathic medicine in any other state and whose license is
174	currently valid and the requirements for practicing in such a
175	capacity are substantially similar to or are more stringent than
176	those of this state.
177	(b)  A health maintenance organization contract that covers
178	a resident of this state and that is issued, amended, delivered,
179	or renewed in this state on or after July 1, 2006, shall provide
180	coverage for the diagnosis and treatment of Lyme disease and its
181	sequelae, including, but not limited to, long-term antibiotic
182	therapy or other newly developed evidence-based therapy to
183	control Lyme disease and its sequelae, when a physician deems
184	the treatment to be medically necessary and orders such therapy
185	after making a thorough evaluation of the patient's symptoms and
186	signs, diagnostic test results, and response to treatment and
187	the physician has documented objective clinical change.
188	(c)  This subsection shall apply to a physician who is
189	licensed to practice medicine or osteopathic medicine in any
190	other state and whose license is currently valid and the
191	requirements for practicing in such a capacity are substantially
192	similar to or are more stringent than those of this state,
193	provided a referral for the required coverage is made in
194	accordance with the procedures authorized by the health
195	maintenance organization contract.
196	Section 5.  This act shall take effect July 1, 2006.

CODING: Words stricken are deletions; words underlined are additions.