What's happening
This bill directs a study on how health insurance coverage affects patient access to care and treatment for Lyme disease in New York.
Why it matters
The bill mandates a detailed review of how health insurance currently covers Lyme and tick-borne diseases, which could highlight gaps in patient access to necessary treatments. This matters because many patients report challenges in getting insurers to pay for comprehensive or long-term care.
It requires analysis of why insurers deny coverage for these diseases, potentially exposing systemic issues or inconsistencies in insurance practices that affect patient outcomes. Understanding these reasons could inform future policy changes or reforms.
By comparing New York’s insurance requirements with those of other states and estimating the costs of expanded coverage, the study could provide a foundation for equitable and evidence-based policy decisions. This could lead to more consistent care for patients regardless of where they live in New York.
The study's findings and recommendations, to be submitted within 180 days, could lead to significant legislative or regulatory changes impacting both insurance companies and the thousands affected by Lyme and other tick-borne diseases in New York. This timeline ensures that the issue will be addressed promptly and could drive actionable change.
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Who cares
Headline styles
Study Lyme Care Insurance
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1295
2019-2020 Regular Sessions
IN SENATE
January 14, 2019
Introduced by Sens. SERINO, CARLUCCI, JACOBS, KENNEDY, LITTLE, RITCHIE, SEWARD, TEDISCO -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT directing the superintendent of financial services to study the relationship between patient access to care and treatment of Lyme disease and health insurance coverage
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The legislature hereby finds that the increasing number of Lyme disease and tick-borne related diseases in New York state highlights the need to examine the relationship between patient access to care and treatment of Lyme disease and health insurance coverage. Lyme disease is one of several tick-borne diseases that may result in symptoms including, but not limited to, extreme and long-term fatigue, nausea, depression, and joint pain. Lyme disease is the most common vector-borne illness in the United States and New York is one of a group of 14 states that account for 95% of cases in the United States. According to the New York State Department of Health, over 20,000 cases of Lyme disease were diagnosed between years 2012 and 2014.
§ 2. The superintendent of financial services, in consultation with the commissioner of health, shall review the status of health insurance coverage for the treatment of Lyme disease and other tick-borne related diseases, and make recommendations regarding potential changes to insurance coverage requirements and parameters. Such review shall include, but not be limited to:
(a) The current range of insurance coverage for the treatment of Lyme and other tick-borne related diseases within New York State;
(b) Reasons for insurer denial of coverage for the treatment of Lyme and other tick-borne related diseases;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06842-01-9
S. 1295 2
(c) Insurance coverage required by other states for the treatment of symptoms related to Lyme and other tick-borne diseases and their estimated costs and payment models;
(d) The estimated cost of expanding coverage for the treatment of symptoms related to Lyme disease and other tick-borne related diseases.
§ 3. Within one hundred eighty days of the effective date of this act, the superintendent of financial services shall submit a report to the governor, temporary president of the senate and the speaker of the assembly of the department of financial services' findings, conclusions and recommendations.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act directing the superintendent of financial services to study the relationship between patient access to care and treatment of Lyme disease and health insurance coverage
Purpose
To review the status of health insurance coverage for the treatment of Lyme and other tick-borne related diseases.
Summary of provisions
Section 1: Provides legislative findings.
Section 2: Directs the superintendent of the Department of Financial Services, in consultation with the commissioner of the Department of Health, to review various provisions related to the costs and range of insurance coverage of Lyme and other tick-borne related diseases.
Section 3: Requires the superintendent to submit a report of the depart- ment's findings, conclusions, and recommendations within 180 days of the effective date of this act.
Section 4: Provides the effective date.
Justification
Over 20,000 cases of Lyme disease were diagnosed in New York State between the years 2012 and 2014, and the epidemic is rapidly spreading across New York-beyond the Hudson Valley and Long Island where the disease was primarily concentrated within the state. While New York has taken action to combat in the spread of Lyme and other tick-borne related diseases, it is important that we consider the toll such diseases have taken on those who are unfortunate enough to contract them, as well as ways to improve their health care outcomes. The New York State Health Care Quality and Cost Containment Commission was established by Chapter 57 of the laws of 2007 to study proposed changes to individual and group health insurance policies, contracts and plans and the potential impacts they may have. While the Cost Containment Commission would be well suited to comprehensively investigate changes to health insurance coverage - particularly Lyme and other tick-borne diseases - the commission has never convened and its funding has been dissolved through the budget process.
Unfortunately, the need for comprehensive examinations of how new cover- age will impact consumer insurance costs and patient access are still present. We have seen this need with respect to in vitro fertilization and fertility treatments. In March of 2018, it was announced that the Department of Financial Services would examine approaches to incorporat- ing in vitro fertilization into health plans. As part of the study, the Department of Financial Services will examine, among other things, the insurance premium consequences of in vitro fertilization coverage, recommendations for appropriate coverage limitations to treatment requirements, comparative state experiences in expanding coverage, and recommendations for improved access for patients. While the commission would have been an entity charged with considering these questions across medical conditions, it is important that we work to ensure that patient access to care is responsibly considered. As such, the unique geographical spread of Lyme and tick-borne diseases, as well as the disproportionate patient impacts in New York, make these diseases ripe for consideration.
This bill would require that the Department of Financial Services conduct a similar study considering the current scope of health insur- ance coverage for Lyme and tick-borne diseases, as well as initiatives in other states and the fiscal implications of various proposals. This is a major step in establishing a conversation on what can be done to address this prevalent issue in New York, and what appropriate responses and coverage may look like.
Legislative history
2018: S.8539 Passed Senate
Fiscal implications
None.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.