2021 -- H 5897

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LC001604

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO BUSINESS AND PROFESSIONS - LYME DISEASE DIAGNOSIS AND

TREATMENT

     

     Introduced By: Representatives Vella-Wilkinson, Solomon, Williams, Ruggiero, and
McNamara

     Date Introduced: February 24, 2021

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-62 of the General Laws in Chapter 27-18 entitled "Accident

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and Sickness Insurance Policies" is hereby amended to read as follows:

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     27-18-62. Mandatory coverage for certain lyme disease treatments.

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

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group hospital or medical services plan contract delivered, issued for delivery, or renewed in this

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state on or after January 1, 2004 shall provide coverage for diagnostic testing and any prescription

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drug treatment including long-term antibiotic treatment of chronic lyme disease when determined

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to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of

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title 5 entitled "lyme disease diagnosis and treatment" after making a thorough evaluation of the

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patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible

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for benefits pursuant to this section shall not be denied solely because such treatment may be

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characterized as unproven, experimental, or investigational in nature. Provided, however, this

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section shall not 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 2. Section 27-19-53 of the General Laws in Chapter 27-19 entitled "Nonprofit

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Hospital Service Corporations" is hereby amended to read as follows:

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     27-19-53. Mandatory coverage for certain lyme disease treatments.

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

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group hospital or medical services plan contract delivered, issued for delivery, or renewed in this

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state on or after January 1, 2004 shall provide coverage for diagnostic testing and any prescription

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drug treatment including long term antibiotic treatment of chronic lyme disease when determined

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to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of

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title 5 entitled "lyme disease diagnosis and treatment" after making a thorough evaluation of the

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patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible

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for benefits pursuant to this section shall not be denied solely because such treatment may be

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characterized as unproven, experimental, or investigational in nature.

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     SECTION 3. Section 27-20-48 of the General Laws in Chapter 27-20 entitled "Nonprofit

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Medical Service Corporations" is hereby amended to read as follows:

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     27-20-48. Mandatory coverage for certain lyme disease treatments.

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

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group hospital or medical services plan contract delivered, issued for delivery, or renewed in this

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state on or after January 1, 2004 shall provide coverage for diagnostic testing and any prescription

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drug treatment including long-term antibiotic treatment of chronic lyme disease when determined

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to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of

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title 5 entitled "lyme disease diagnosis and treatment" after making a thorough evaluation of the

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patient's symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible

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for benefits pursuant to this section shall not be denied solely because such treatment may be

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characterized as unproven, experimental, or investigational in nature.

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     SECTION 4. Section 27-41-65 of the General Laws in Chapter 27-41 entitled "Health

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Maintenance Organizations" is hereby amended to read as follows:

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

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     Subscribers to any health maintenance organization plan shall be afforded coverage under

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that plan on or after January 1, 2004 for diagnostic testing and any prescription drug treatment

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including long term antibiotic treatment of chronic lyme disease when determined to be medically

 

LC001604 - Page 2 of 4

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necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled "lyme

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disease 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 pursuant

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

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experimental, or investigational in nature.

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     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESS AND PROFESSIONS - LYME DISEASE DIAGNOSIS AND

TREATMENT

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     This act would require insurers to provide coverage for any prescription drug treatment for

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lyme disease.

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     This act would take effect upon passage.

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