2003 -- H 6136 SUBSTITUTE A

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LC02608/SUB A

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2003

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A N A C T

RELATING TO HEALTH AND SAFETY -- LYME DISEASE DIAGNOSIS AND

TREATMENT

     Introduced By: Representatives Gallison, Anguilla, Enos, Lewiss, and Amaral

     Date Introduced: February 27, 2003

     Referred To: House Health, Education & Welfare

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 5-37.5-2 of the General Laws in Chapter 5-37.5 entitled "Lyme

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Disease Diagnosis and Treatment" is hereby amended to read as follows:

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     5-37.5-2. Preamble. -- WHEREAS, The Governor's Commission on Lyme Disease and

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Other Tick-Borne Diseases (the "Commission") was formed by executive order in 2002; and

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      WHEREAS, The General Assembly recognizes the negative impact of Lyme disease on

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Rhode Islanders; and

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      WHEREAS, Rhode Island has the second highest number of reported Lyme disease

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cases as a percentage of population in the United States; and

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      WHEREAS, The Commission and the General Assembly held hearings and reviewed the

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medical literature to gain an understanding of the concerns of citizens and the medical community

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about Lyme disease diagnosis, treatment and prevention; and

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      WHEREAS, Citizens of Rhode Island diagnosed with chronic lyme disease experience

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great difficulty in being diagnosed and treated thereby impairing their access to medical care; and

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      WHEREAS, The lack of insurance coverage for diagnosis and long-term antibiotic

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therapies is a major barrier to access to medical care for persons with symptoms compatible with

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chronic Lyme disease; and

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      WHEREAS, Physicians whose practices are devoted to treating chronic Lyme disease

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patients, and who continue to provide treatment if they feel such treatment is medically necessary,

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have noted significant improvement in the condition of their patients; and

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      WHEREAS, There is substantial evidence that considerable scientific controversy

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surrounds the diagnosis and treatment of Lyme disease and other tick-borne illnesses; and

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      WHEREAS, Laboratory tests for Lyme disease are not definitive and consensus

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guidelines for diagnosis and treatment of chronic Lyme disease have not been developed; and

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      WHEREAS, Some physicians feel threatened by insurers and licensing boards for their

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choices among possible therapies for their patients; and

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      WHEREAS, The Commission and this General Assembly recommend that legislation be

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adopted that promotes access to medical care for persons with chronic Lyme disease in Rhode

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Island; and

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      Now, therefore, it is enacted by the General Assembly as follows:

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     SECTION 2. Chapter 5-37.5 of the General Laws entitled "Lyme Disease Diagnosis and

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Treatment" is hereby amended by adding thereto the following section:

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     5-37.5-5. Mandatory coverage for certain lyme disease treatments. – Every individual

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or group hospital or medical expense insurance policy or individual or group hospital or medical

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services plan contract delivered, issued for delivery, or renewed in this state on or after January 1,

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2004, shall provide for lyme disease treatment as provided in chapters 27-18, 27-19, 27-20, and

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27-41 of the general laws.

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     SECTION 3. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-62. Mandatory coverage for certain lyme disease treatments. – (a) Every

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individual or group hospital or medical expense insurance policy or individual or group hospital

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or medical services plan contract delivered, issued for delivery, or renewed in this state on or after

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January 1, 2004 shall provide coverage for diagnostic testing and long-term antibiotic treatment

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of chronic lyme disease when determined to be medically necessary and ordered by a physician

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acting in accordance with chapter 5-37.5 of the Rhode Island General Laws entitled "lyme disease

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diagnosis and treatment" after making a thorough evaluation of the patient's symptoms,

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diagnostic test results and response to treatment. Treatment otherwise eligible for benefits

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pursuant to this section shall not be denied solely because such treatment may be characterized as

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unproven, experimental, or investigational in nature. Provided, however, this section shall not

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apply to insurance coverage providing benefits for:

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     (1) hospital confinement indemnity;

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     (2) disability income;

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     (3) accident only;

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     (4) long-term care;

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     (5) Medicare supplement;

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     (6) limited benefit health;

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     (7) specified disease indemnity;

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     (8) sickness or bodily injury or death by accident or both; and

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     (9) other limited benefit policies.

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     SECTION 4. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-19-53. Mandatory coverage for certain lyme disease treatments. – (a) Every

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individual or group hospital or medical expense insurance policy or individual or group hospital

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or medical services plan contract delivered, issued for delivery, or renewed in this state on or after

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January 1, 2004 shall provide coverage for diagnostic testing and long term antibiotic treatment

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of chronic lyme disease when determined to be medically necessary and ordered by a physician

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acting in accordance with chapter 5-37.5 of the Rhode Island General Laws entitled "lyme disease

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diagnosis and treatment" after making a thorough evaluation of the patient's symptoms,

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diagnostic test results and response to treatment. Treatment otherwise eligible for benefits

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pursuant to this section shall not be denied solely because such treatment may be characterized as

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unproven, experimental, or investigational in nature.

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     SECTION 5. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20-48. Mandatory coverage for certain lyme disease treatments. -- (a) Every

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individual or group hospital or medical expense insurance policy or individual or group hospital

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or medical services plan contract delivered, issued for delivery, or renewed in this state on or after

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January 1, 2004 shall provide coverage for diagnostic testing and long-term antibiotic treatment

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of chronic lyme disease when determined to be medically necessary and ordered by a physician

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acting in accordance with chapter 5-37.5 of the Rhode Island General Laws entitled "lyme disease

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diagnosis and treatment" after making a thorough evaluation of the patient's symptoms,

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diagnostic test results and response to treatment. Treatment otherwise eligible for benefits

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pursuant to this section shall not be denied solely because such treatment may be characterized as

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unproven, experimental, or investigational in nature.

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     SECTION 6. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations" is hereby amended by adding thereto the following section:

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     27-41-65. Mandatory coverage for certain lyme disease treatments. – Subscribers to

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any health maintenance organization plan shall be afforded coverage under that plan on or after

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January 1, 2004 for diagnostic testing and long term antibiotic treatment of chronic lyme disease

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when determined to be medically necessary and ordered by a physician acting in accordance with

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chapter 5-37.5 of the Rhode Island General Laws entitled "lyme disease diagnosis and treatment"

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after making a thorough evaluation of the patient's symptoms, diagnostic test results and response

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to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied

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solely because such treatment may be characterized as unproven, experimental, or investigational

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in nature.

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     SECTION 7. This act shall take effect upon passage.

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LC02608/SUB A

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY -- LYME DISEASE DIAGNOSIS AND

TREATMENT

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     This act would require health insurance plans to provide coverage for lyme disease

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diagnosis and treatment when determined to be medically necessary and ordered by a physician.

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     This act would take effect upon passage.

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LC02608/SUB A

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