Senate Bill sb2022
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 2022
By Senator Wise
5-1385-06 See HB 1013
1 A bill to be entitled
2 An act relating to Lyme disease; providing a
3 short title; creating s. 381.801, F.S.;
4 providing definitions; requiring certain health
5 insurance policies and health maintenance
6 organization contracts to provide coverage for
7 Lyme disease diagnosis and treatment; creating
8 s. 627.64194, F.S.; providing definitions;
9 requiring certain health insurance policies to
10 provide coverage for Lyme disease diagnosis and
11 treatment; providing applicability for
12 referrals made in accordance with procedures
13 authorized by health insurance policies;
14 amending s. 641.31, F.S.; providing
15 definitions; requiring certain health
16 maintenance organization contracts to provide
17 coverage for Lyme disease diagnosis and
18 treatment; providing applicability for
19 referrals made in accordance with procedures
20 authorized by health maintenance organization
21 contracts; providing an effective date.
22
23 WHEREAS, the Legislature recognizes that Lyme disease
24 exists in Florida and has a negative impact on its citizens,
25 and
26 WHEREAS, Lyme disease is the most common vector-borne
27 disease in the United States and other tick-associated
28 diseases are being identified, and
29 WHEREAS, the Department of Health maintains that early
30 diagnosis and proper treatment of Lyme disease are important
31
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Florida Senate - 2006 SB 2022
5-1385-06 See HB 1013
1 strategies in avoiding the complications and expenses of
2 infection and late-stage illness, and
3 WHEREAS, the lack of insurance coverage for diagnosis
4 and long-term antibiotic therapies or other newly developed
5 evidence-based therapies or treatment is a major barrier to
6 adequate medical care for patients with symptoms compatible
7 with chronic Lyme disease, and
8 WHEREAS, the Legislature feels a responsibility to help
9 the citizens of the state who suffer from Lyme disease and who
10 may not obtain a timely diagnosis or obtain the appropriate
11 treatment, and to protect the physicians who treat sufferers
12 of Lyme disease, by adopting legislation that promotes the
13 diagnosis and treatment of Lyme disease in Florida, NOW,
14 THEREFORE,
15
16 Be It Enacted by the Legislature of the State of Florida:
17
18 Section 1. This act may be cited as the "Lyme Disease
19 Insurance Coverage Act."
20 Section 2. Section 381.801, Florida Statutes, is
21 created to read:
22 381.801 Lyme disease; definitions; coverage.--
23 (1) For purposes of this section:
24 (a) "Coverage" means an insurer may not contest,
25 reverse, or deny payment for diagnostic testing or long-term
26 antibiotic therapy or other newly developed evidence-based
27 therapy based upon a physician's order, whether the physician
28 is in a preferred provider network as defined in s.
29 627.6471(1)(c) or not, if the treating physician has
30 determined the therapy to be medically necessary.
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Florida Senate - 2006 SB 2022
5-1385-06 See HB 1013
1 (b) "Long-term antibiotic therapy" means
2 administration of oral, intramuscular, or intravenous
3 antibiotics, singly or in combination, for a period of more
4 than 4 weeks.
5 (c) "Lyme disease" means the clinical diagnosis by a
6 physician of the presence in a patient of signs and symptoms
7 compatible with acute, late-stage, recurrent, or chronic
8 infection with Borrelia burgdorferi or with complications
9 related to such an infection. Lyme disease includes an
10 infection that meets the surveillance criteria set forth by
11 the Centers for Disease Control and Prevention and also
12 includes other acute, late-stage, recurrent, and chronic
13 manifestations of such an infection as determined by the
14 treating physician.
15 (d) "Medically necessary" means the use of long-term
16 antibiotic therapy or other newly developed evidence-based
17 therapy that the physician has determined is necessary in a
18 particular case based on the patient's symptoms, signs, and
19 responsiveness to the treatment prescribed by the physician.
20 (e) "Physician" means a person licensed to practice
21 medicine under chapter 458 or osteopathic medicine under
22 chapter 459 or a person who is licensed to practice medicine
23 or osteopathic medicine in any other state and whose license
24 is currently valid and the requirements for practicing in such
25 a capacity are substantially similar to or are more stringent
26 than those of this state.
27 (2) Health insurance policies and health maintenance
28 organization contracts shall provide coverage for the
29 diagnosis and treatment of Lyme disease, including long-term
30 antibiotic therapy or other newly developed evidence-based
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Florida Senate - 2006 SB 2022
5-1385-06 See HB 1013
1 therapy, as deemed to be medically necessary by a physician,
2 as specified in ss. 627.64194 and 641.31(36).
3 Section 3. Section 627.64194, Florida Statutes, is
4 created to read:
5 627.64194 Required coverage for Lyme disease.--
6 (1) As used in this section:
7 (a) "Coverage" means an insurer may not contest,
8 reverse, or deny payment for diagnostic testing or long-term
9 antibiotic therapy or other newly developed evidence-based
10 therapy based upon a physician's order, whether the physician
11 is in a preferred provider network as defined in s.
12 627.6471(1)(c) or not, if the treating physician has
13 determined the therapy to be medically necessary.
14 (b) "Long-term antibiotic therapy" means
15 administration of oral, intramuscular, or intravenous
16 antibiotics, singly or in combination, for a period of more
17 than 4 weeks.
18 (c) "Lyme disease" means the clinical diagnosis by a
19 physician of the presence in a patient of signs and symptoms
20 compatible with acute, late-stage, recurrent, or chronic
21 infection with Borrelia burgdorferi or with complications
22 related to such an infection. Lyme disease includes an
23 infection that meets the surveillance criteria set forth by
24 the Centers for Disease Control and Prevention and also
25 includes other acute, late-stage, recurrent, and chronic
26 manifestations of such an infection as determined by the
27 treating physician.
28 (d) "Medically necessary" means the use of long-term
29 antibiotic therapy or other newly developed evidence-based
30 therapy that the physician has determined is necessary in a
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 2022
5-1385-06 See HB 1013
1 particular case based on the patient's symptoms, signs, and
2 responsiveness to the treatment prescribed by the physician.
3 (e) "Physician" means a person licensed to practice
4 medicine under chapter 458 or osteopathic medicine under
5 chapter 459 or a person who is licensed to practice medicine
6 or osteopathic medicine in any other state and whose license
7 is currently valid and the requirements for practicing in such
8 a capacity are substantially similar to or are more stringent
9 than those of this state.
10 (2) A health insurance policy that covers a resident
11 of this state and that is issued, amended, delivered, or
12 renewed in this state on or after July 1, 2006, shall provide
13 coverage for the diagnosis and treatment of Lyme disease and
14 its sequelae, including, but not limited to, long-term
15 antibiotic therapy or other newly developed evidence-based
16 therapy to control Lyme disease and its sequelae, when a
17 physician deems the treatment to be medically necessary and
18 orders such therapy after making a thorough evaluation of the
19 patient's symptoms and signs, diagnostic test results, and
20 response to treatment and the physician has documented
21 objective clinical change.
22 (3) This section shall apply to a physician who is
23 licensed to practice medicine or osteopathic medicine in any
24 other state and whose license is currently valid and the
25 requirements for practicing in such a capacity are
26 substantially similar to or are more stringent than those of
27 this state, provided a referral for the required coverage is
28 made in accordance with the procedures authorized by the
29 health insurance policy.
30 Section 4. Subsections (36) through (40) of section
31 641.31, Florida Statutes, are renumbered as subsections (37)
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Florida Senate - 2006 SB 2022
5-1385-06 See HB 1013
1 through (41), respectively, and a new subsection (36) is added
2 to that section to read:
3 641.31 Health maintenance contracts.--
4 (36)(a) As used in this subsection:
5 1. "Coverage" means an insurer may not contest,
6 reverse, or deny payment for diagnostic testing or long-term
7 antibiotic therapy or other newly developed evidence-based
8 therapy based upon a physician's order, whether the physician
9 is in a health maintenance organization's provider network or
10 not, if the treating physician has determined the therapy to
11 be medically necessary.
12 2. "Long-term antibiotic therapy" means administration
13 of oral, intramuscular, or intravenous antibiotics, singly or
14 in combination, for a period of more than 4 weeks.
15 3. "Lyme disease" means the clinical diagnosis by a
16 physician of the presence in a patient of signs and symptoms
17 compatible with acute, late-stage, recurrent, or chronic
18 infection with Borrelia burgdorferi or with complications
19 related to such an infection. Lyme disease includes an
20 infection that meets the surveillance criteria set forth by
21 the Centers for Disease Control and Prevention and also
22 includes other acute, late-stage, recurrent, and chronic
23 manifestations of such an infection as determined by the
24 treating physician.
25 4. "Medically necessary" means the use of long-term
26 antibiotic therapy or other newly developed evidence-based
27 therapy that the physician has determined is necessary in a
28 particular case based on the patient's symptoms, signs, and
29 responsiveness to the treatment prescribed by the physician.
30 5. "Physician" means a person licensed to practice
31 medicine under chapter 458 or osteopathic medicine under
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 2022
5-1385-06 See HB 1013
1 chapter 459 or a person who is licensed to practice medicine
2 or osteopathic medicine in any other state and whose license
3 is currently valid and the requirements for practicing in such
4 a capacity are substantially similar to or are more stringent
5 than those of this state.
6 (b) A health maintenance organization contract that
7 covers a resident of this state and that is issued, amended,
8 delivered, or renewed in this state on or after July 1, 2006,
9 shall provide coverage for the diagnosis and treatment of Lyme
10 disease and its sequelae, including, but not limited to,
11 long-term antibiotic therapy or other newly developed
12 evidence-based therapy to control Lyme disease and its
13 sequelae, when a physician deems the treatment to be medically
14 necessary and orders such therapy after making a thorough
15 evaluation of the patient's symptoms and signs, diagnostic
16 test results, and response to treatment and the physician has
17 documented objective clinical change.
18 (c) This subsection shall apply to a physician who is
19 licensed to practice medicine or osteopathic medicine in any
20 other state and whose license is currently valid and the
21 requirements for practicing in such a capacity are
22 substantially similar to or are more stringent than those of
23 this state, provided a referral for the required coverage is
24 made in accordance with the procedures authorized by the
25 health maintenance organization contract.
26 Section 5. This act shall take effect July 1, 2006.
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