Amendment #729 to H4200

Lyme Disease Treatment Coverage

Mr. Linsky of Natick moves to amend the bill by adding the following new sections:

SECTION XXX. Chapter 175 of the General Laws is hereby amended by inserting after

section 47DD, the following section:

Section 47EE.

(A) For the purposes of this Section, the terms “Lyme disease” and “long-term antibiotic

therapy” are given the same definition as provided in M.G.L. Chapter 112, Section 12DD.

(B) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides medical expense coverage shall provide coverage for long-term antibiotic therapy of Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment. Long-term antibiotic therapy 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.

SECTION XXX. Chapter 176A of the General Laws is hereby amended by inserting after

section 8FF the following section:-

Section 8GG. Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for long-term antibiotic therapy of Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results or 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.

SECTION XXX. Chapter 176B of the General Laws is hereby amended by inserting after section 4FF, the following section:-

Section 4GG. Any subscription certificate under an individual or group medical service agreement delivered, issued, or renewed within the commonwealth shall provide coverage for long-term antibiotic therapy of Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results or 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.

SECTION XXX. Chapter 176G of the General Laws is hereby amended by inserting after

section 4X the following section:-

Section 4Y. Any individual or group health maintenance contract shall provide coverage

for long-term antibiotic therapy of Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results or 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.

Additional co-sponsor(s) added to Amendment #729, as changed to H4200

Lyme Disease Treatment Coverage