TEXT: Massachusetts House Bill 4259 (“H.4259”)

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The Commonwealth of Massachusetts
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In the Year Two Thousand Fourteen
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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:

1 SECTION 1. Chapter 32A of the General Laws, as appearing in the 2012 Official
2 Edition, is hereby amended by inserting after section 17K the following section:-
3 Section 17L. Any coverage offered by the commission to an active or retired employee of
4 the commonwealth insured under the group insurance commission that provides coverage for
5 cancer chemotherapy treatment shall provide coverage for Lyme disease therapy.
6 SECTION 2. Chapter 175 of the General Laws, as so appearing, is hereby amended by
7 inserting after section 47DD, the following section:-
8 Section 47EE. Any policy, contract, agreement, plan or certificate of insurance issued,
9 delivered or renewed within the commonwealth that provides medical expense coverage shall
10 provide coverage for diagnostic testing and long-term antibiotic treatment of Lyme disease when
11 determined to be medically necessary and ordered by a physician after making a thorough
12 evaluation of the patient’s symptoms, diagnostic test results and response to therapy. Therapy
13 otherwise eligible for benefits pursuant to this section shall not be denied solely because such
14 therapy may be characterized as unproven, experimental, or investigational in nature.
15 SECTION 3. Chapter 176A of the General Laws, as so appearing, is hereby amended by
16 inserting after section 8FF the following section:-
17 Section 8GG. Any contract between a subscriber and the corporation under an individual
18 or group hospital service plan which is delivered, issued or renewed within the commonwealth
19 shall provide coverage for diagnostic testing and long-term antibiotic therapy for Lyme disease
20 when determined to be medically necessary and ordered by a physician after making a thorough
21 evaluation of the patient’s symptoms, diagnostic test results and response to therapy. Therapy
22 otherwise eligible for benefits pursuant to this section shall not be denied solely because such
23 therapy may be characterized as unproven, experimental, or investigational in nature.
24 SECTION 4. Chapter 176B of the General Laws, as so appearing, is hereby amended by
25 inserting after section 4FF, the following section:-
26 Section 4GG. Any subscription certificate under an individual or group medical service
27 agreement delivered, issued, or renewed within the commonwealth shall provide coverage for
28 diagnostic testing and long-term antibiotic therapy for Lyme disease when determined to be
29 medically necessary and ordered by a physician after making a thorough evaluation of the
30 patient’s symptoms, diagnostic test results and response to therapy. Therapy otherwise eligible
31 for benefits pursuant to this section shall not be denied solely because such therapy may be
32 characterized as unproven, experimental, or investigational in nature.
33 SECTION 5. Chapter 176G of the General Laws, as so appearing, is hereby amended by
34 inserting after section 4X the following section:-
35 Section 4Y. Any individual or group health maintenance contract shall provide coverage
36 for diagnostic testing and long-term antibiotic therapy for Lyme disease when determined to be
37 medically necessary and ordered by a physician after making a thorough evaluation of the
38 patient’s symptoms, diagnostic test results and response to therapy. Therapy otherwise eligible
39 for benefits pursuant to this section shall not be denied solely because such therapy may be
40 characterized as unproven, experimental, or investigational in nature.

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