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 1 CODING: Words stricken are deletions; words underlined are additions.
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. 31 2 CODING: Words stricken are deletions; words underlined are additions.
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 31 3 CODING: Words stricken are deletions; words underlined are additions.
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 31 4 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) 5 CODING: Words stricken are deletions; words underlined are additions.
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. 27 28 29 30 31 7 CODING: Words stricken are deletions; words underlined are additions.
History
SB 2022- Lyme Disease/Insurance