Budget Amendment ID: FY2017-S4-427-R1

Redraft EHS 427

Lyme Disease Coverage

Ms. Gobi, Messrs. Eldridge, Keenan, Moore, Rodrigues and Timilty, Ms. Flanagan, Messrs. Lewis, Ross and Fattman, Ms. Chandler, Mr. Joyce, Ms. L'Italien, Messrs. Brownsberger and Pacheco, Ms. Lovely, Messrs. Brady, Humason and Wolf, Ms. Donoghue, Ms. O'Connor Ives, Ms. Creem, Messrs. McGee, Lesser and Rush moved that the proposed new text be amended by inserting after section 42 the following 8 sections:-

“SECTION 42A. Chapter 175 of the General Laws is hereby amended by inserting after section 47GG the following section:-

Section 47HH. (a) For the purposes of this section, the terms “Lyme disease” and “long-term antibiotic therapy” shall mean “Lyme disease” and “long-term antibiotic therapy” as defined in section 12DD of chapter 112.

(b) A 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 for a patient with Lyme disease if it is: (i) medically necessary; and (ii) ordered by a licensed health care provider after recording an evaluation of the patient’s symptoms, diagnostic test results or response to treatment in the patient’s electronic health record. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for any indication by the United States Food and Drug Administration; provided, further, that a drug, including experimental drugs, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration.

SECTION 42B. Section 47HH of said chapter 175 is hereby repealed.

SECTION 42C. Chapter 176A of the General Laws is hereby amended by inserting after section 8II the following section:-

Section 8JJ. A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease if it is: (i) medically necessary; and (ii) ordered by a licensed health care provider after recording an evaluation of the patient’s symptoms, diagnostic test results or response to treatment in the patient’s electronic health record. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for any indication by the United States Food and Drug Administration; provided, further, that a drug, including experimental drugs, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration.

SECTION 42D. Section 8JJ of said chapter 176A is hereby repealed.

SECTION 42E. Chapter 176B of the General Laws is hereby amended by inserting after section 4II the following section:-

Section 4JJ. A 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 for a patient with Lyme disease if it is: (i) medically necessary; and (ii) ordered by a licensed health care provider after recording an evaluation of the patient’s symptoms, diagnostic test results or response to treatment in the patient’s electronic health record. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for any indication by the United States Food and Drug Administration; provided, further, that a drug, including experimental drugs, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration.

SECTION 42F. Section 4JJ of said chapter 176B is hereby repealed.

SECTION 42G. Chapter 176G of the General Laws is hereby amended by inserting after section 4AA the following section:-

Section 4BB. An individual or group health maintenance contract shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease if it is: (i) medically necessary; and (ii) ordered by a licensed health care provider after recording an evaluation of the patient’s symptoms, diagnostic test results or response to treatment in the patient’s electronic health record. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for any indication by the United States Food and Drug Administration; provided, further, that a drug, including experimental drugs, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration.

SECTION 42H. Section 4BB of said chapter 176G is hereby repealed.”; and

by inserting after section 79 the following section:-

“SECTION 79A. Sections 42B, 42D, 42F and 42H shall take effect on July 1, 2021.”.