HOUSE DOCKET, NO. 527        FILED ON: 1/12/2009

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1038

The Commonwealth of Massachusetts

_______________

In the Year Two Thousand Nine

_______________

An Act relative to Lyme Disease treatment coverage..

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 111, as appearing in the 2004 Official Edition, is hereby amended by inserting, after section 218, the following new sections:

SECTION 219. Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery or renewed in this state on or after January 1, 2010, shall provide for Lyme disease treatment.

SECTION 220. Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery or renewed in this state on or after January 1, 2010, shall provide coverage for diagnostic testing and long-term antibiotic treatment of chronic Lyme disease when determined to be medically necessary and ordered by a physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature. Provided, however, this section shall not apply to insurance coverage providing benefits for:

Hospital confinement indemnity;

Disability income;

Accident only;

Long-term care;

Medicare supplement;

Limited benefit health;

Specified disease indemnity;

Sickness or bodily injury or death by accident or both; and

Other limited benefit policies.

Section 221. Subscribers to any health maintenance organization plan shall be afforded coverage under that plan on or after January 1, 2010 for diagnostic testing and long term antibiotic treatment of chronic Lyme disease when determined to be medically necessary and ordered by a physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature.