An Act To Implement the Recommendations of the Joint Standing Committee on Insurance and Financial Services Regarding Reporting on Lyme Disease and Other Tick-borne Illnesses
Maine Legislature, Session 123, LD 2157
Committee Amendment CA_B_S481 (Senate)
Amends: 24 MRSA §2317-B, 24-A MRSA §2745-H, 24-A MRSA §2837, 24-A MRSA §4244-A, 32 MRSA §3300-B

. Minority 
COMMITTEE AMENDMENT" .8" to S.P. 825, L.D. 2157, Bill, "An Act To 
Implement the Recommendations of the Joint Standing Committee on Insurance and 
Financial Services Regarding Reporting on Lyme Disease and Other Tick-borne 
Illnesses" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Require Health Insurance Coverage for the Treatment and 
Diagnosis of Lyme Disease' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'PART A 
Sec. A-I. 24 MRSA §2317-B, sub-§12-C is enacted to read: 
12-C. Title 24-A, sections 2745-H, 2837-1 and 4244-A. 
Coverage for certain 
Lyme disease treatments, Title 24-A, sections 2745-H, 2837-1 and 4244-A; 
Sec. A-2. 24-A MRSA §2745-H is enacted to read: 
§2745-H. Coverage for certain Lyme disease treatments 
1. Required coverage. All individual health insurance policies and contracts must 
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 
acting in accordance with Title 32, section 3300-B 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 may not be denied solely because 
such treatment might be characterized as unproven, experimental or investigational in 
nature. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" 8 " 
to S.P. 825, L.D.2157 
2. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State. 
For purposes of this section. all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
Sec. A-3. 24-A MRSA §2837-1 is enacted to read: 
§2837-I. Coverage for certain Lyme disease treatments 
1. Required coverage. All group health insurance policies and contracts must 
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 
acting in accordance with Title 32, section 3300-B 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 may not be denied solely because 
such treatment might be characterized as unproven, experimental or investigational in 
nature. 
2. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State. 
For purposes of this section, all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
Sec. A-4. 24-A MRSA §4244-A is enacted to read: 
§4244-A. Coverage for certain Lyme disease treatments 
1. Required coverage. All health maintenance organization individual and group 
contracts must 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 acting in accordance with Title 32, section 3300-B 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 may not be denied 
solely because such treatment might be characterized as unproven, experimental or 
investigational in nature. 
2. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State. 
For purposes of this section, all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
Sec. A-S. 32 MRSA §3300-B is enacted to read: 
§3300-B. Lyme disease diagnosis and treatment 
1. Definitions. For purposes of this section, unless the context indicates otherwise, 
the following terms have the following meanings. 
A. "Long-term antibiotic therapy" means administration of oral, intramuscular or 
intravenous antibiotics, singly or in combination, for periods of greater than 4 weeks. 
B. "Lyme disease" means the clinical diagnosis by a physician of the presence in a 
patient of signs and symptoms compatible with acute infection with Borrelia 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" B " to S.P. 825, L.D. 2157 
burgdorferi. or with late stage or chronic infection with Borrelia burgdorferi, or with 
complications related to such an infection. "Lyme disease" includes infection that 
meets the surveillance criteria set forth by the United States Centers for Disease 
Control and Prevention but also includes other acute and chronic manifestations of 
such an infection as determined by the physician. 
C. "Physician" means a person licensed pursuant to this chapter by the board. 
D. 
"Therapeutic purpose" means the use of antibiotics to control a patient's 
symptoms determined by the physician as reasonably related to Lyme disease and its 
seguelae. 
2. 
Long-term antibiotic therapy. 
A physician may prescribe, administer or 
dispense long-term antibiotic therapy for a therapeutic purpose to a person diagnosed 
with and having symptoms of Lyme disease if this diagnosis and treatment plan has been 
documented in the physician's medical record for that patient. A physician may not be 
subject to disciplinary action by the board solely for prescribing, administering or 
dispensing long-term antibiotic therapy for a therapeutic purpose for a patient clinically 
diagnosed with Lyme disease if this diagnosis and treatment plan has been documented in 
the physician's medical record for that patient. This subsection may not be construed to 
prohibit the right of the board to deny, revoke or suspend the license of any physician or 
discipline any physician who prescribes, administers or dispenses long-term antibiotic 
therapy for a nontherapeutic purpose, who fails to monitor the ongoing care of a patient 
receiving long-term antibiotic therapy or who fails to keep complete and accurate 
ongoing records of the diagnosis and treatment of a patient receiving long-term antibiotic 
therapy. 
Sec. A-6. 
Application. The requirements of this Part apply to all policies, 
contracts and certificates executed, delivered, issued for delivery, continued or renewed 
in this State on or after January 1, 2009. For purposes of this Part, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. A-7. Exemption from review. Notwithstanding the Maine Revised Statutes, 
Title 24-A, section 2752, this Part is enacted without review and evaluation by the 
Department of Professional and Financial Regulation, Bureau of Insurance. 
PARTB 
Sec. B-1. Public health curriculum in elementary schools. The Department 
of Health and Human Services, Maine Center for Disease Control and Prevention shall 
develop a public health education curriculum for all elementary schools in the State 
related to the prevention, diagnosis and treatment of Lyme disease and other tick-borne 
illnesses. 
Sec. B-2. Wildlife management program. The Department of Inland Fisheries 
and Wildlife and the Department of Health and Human Services, Maine Center for 
Disease Control and Prevention shall jointly develop a wildlife management program 
designed to control the prevalence of ticks in the State. The program must be targeted to 
those areas in the State with the highest rates of ticks infected with Lyme disease and the 
highest rates of Lyme disease in Maine residents. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT".B " to S.P. 825, L.D. 2157 
Sec. B-3. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Health - Bureau of 0143 
Initiative: Appropriates funds for the costs of developing the public health curriculum for 
Lyme disease and other tick-borne illnesses and for developing a wildlife management 
program, including the costs of a 0.50 FTE Public Health Educator III position and a 0.20 
FTE Clerk IV position. 
GENERAL FUND 
2007-08 
2008-09 
POSITIONS - FTE COUNT 
0.000 
0.700 
Personal Services 
$0 
$46,661 
All Other 
$0 
$9,587 
GENERAL FUND TOTAL 
$0 
$56,248 
SUMMARY 
This amendment replaces the bill and is the recommendation of the minority of the 
committee as a result of the committee's study and review of issues regarding Lyme 
disease and other tick-borne illnesses between the First Regular Session and Second 
Regular Session of the l23rd Legislature. Part A of the amendment requires health 
insurance companies to provide coverage for the treatment of Lyme disease. The 
mandated coverage applies to all individual and group health insurance policies issued or 
renewed on or after January 1,2009. 
Part B of the amendment requires the Department of Health and Human Services, 
Maine Center for Disease Control and Prevention to develop a public health curriculum 
for the awareness and prevention of Lyme disease and other tick-borne illnesses in 
elementary schools in the State. Part B also requires the Department of Inland Fisheries 
and Wildlife and the Maine Center for Disease Control and Prevention to develop a 
wildlife management program to control the prevalence of ticks that transmit Lyme 
disease in the State. This Part also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 02/27/08 
~ac:.. 
LD 2157 
LR 3444(03) 
An Act To Implement the Recommendations of the Joint Standing Committee on Insurance and 
Financial Services Regarding Reporting on Lyme Disease and Other Tick-borne Illnesses 
Fiscal Note for Bill as Amended by Committee Amendment".B " 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Potential future biennium cost increase - General Fund, Other Funds 
~et Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Fiscal Detail and Notes 
2007-08 
$0 
$0 
2008-09 
$56,248 
$56,248 
Projections 
2009-10 
$57,863 
$57,863 
Projections 
2010-11 
$59,534 
$59,534 
Provides an appropriation of $56,248 in 2008-09 for the Maine Center for Disease Control and Prevention for the 
costs of developing the public health curriculum for Lyme disease and other tick-borne illnesses and for developing a 
wildlife management program, including the costs of a 0.50 FTE Public Health Educator III position and a 0.20 FTE 
Clerk IV position. 
Assumes additional costs to the State Employee Health Plan would not be incurred until fiscal year 2009-10, but the 
precise impact cannot be determined at this time. 
Any additional costs to the Department ofInland Fisheries and Wildlife and to the Bureau oflnsurance in the 
Department of Professional and Financial Services can be absorbed utilizing existing budgeted resources. 
LR3444(03) - Fiscal Note - Page 1 of 1