Establishes the "Missouri Lyme Disease Eradication Act"

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 887
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR SCHROER.
5289S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 192.020, RSMo, and to enact in lieu thereof five new sections relating to Lyme
disease.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 192.020, RSMo, is repealed and five 1
new sections enacted in lieu thereof, to be known as sections 2
192.020, 192.026, 192.027, 192.028, and 376.1223, to read as 3
follows:4
192.020. 1. It shall be the general duty and 1
responsibility of the department of health and senior 2
services to safeguard the health of the people in the state 3
and all its subdivisions. It shall make a study of the 4
causes and prevention of diseases. It shall designate those 5
diseases which are infectious, contagious, communicable or 6
dangerous in their nature and shall make and enforce 7
adequate orders, findings, rules and regulations to prevent 8
the spread of such diseases and to determine the prevalence 9
of such diseases within the state. It shall have power and 10
authority, with approval of the director of the department, 11
to make such orders, findings, rules and regulations as will 12
prevent the entrance of infectious, contagious and 13
communicable diseases into the state. 14
2. The department of health and senior services shall 15
include in its list of communicable or infectious diseases 16
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which must be reported to the department methicillin- 17
resistant staphylococcus aureus (MRSA), carbapenem-resistant 18
enterobacteriaceae (CRE) as specified by the department, 19
[and] vancomycin-resistant enterococcus (VRE), and Lyme 20
disease. 21
192.026. 1. This section and sections 192.027, 1
192.028, and 376.1223 shall be known and may be cited as the 2
"Missouri Lyme Disease Eradication Act". 3
2. As used in this section and sections 192.027, 4
192.028, and 376.1223, the following terms shall mean: 5
(1) "Department", the department of health and senior 6
services; 7
(2) "Lyme disease", a condition caused by an infection 8
of the bacterium Borrelia burgdorferi, Borrelia mayonii, 9
Borrelia afzelii, Borrelia garinii, Borrelia valaisiana, 10
Borrelia lusitaniae, Bartonella, Babesia, Ehrlichia, or 11
related species, transmitted to humans through the bite of 12
infected blacklegged ticks (Ixodes scapularis) or other 13
ticks, as diagnosed by the two-tier serologic testing 14
recommended by the federal Centers for Disease Control and 15
Prevention (CDC) or by a similar blood test ordered by a 16
treating health care provider or by clinical evaluation; 17
(3) "Medically necessary", health care services or 18
products that a treating health care provider exercising 19
prudent clinical judgment would provide to a patient for the 20
purpose of preventing, evaluating, diagnosing, or treating 21
an illness, injury, disease, or symptoms of such, and that 22
are: 23
(a) Clinically appropriate in terms of type, 24
frequency, extent, site, and duration for the specific 25
circumstances; and 26
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(b) Not primarily for the mere convenience of the 27
patient, health care provider, or as determined by the 28
provider based on the patient's specific circumstances; 29
(4) "Posttreatment Lyme disease syndrome", a condition 30
characterized by persistent symptoms, including, but not 31
limited to, fatigue, pain, respiratory impairment, 32
neurological impairment, or other cognitive impairment 33
following standard antibiotic or other treatment for Lyme 34
disease. 35
3. Health care providers, laboratories, and local 36
health departments shall report to the department all 37
confirmed or suspected cases of Lyme disease within seven 38
days of diagnosis using standardized surveillance case 39
definitions developed by the CDC. 40
4. The department shall compile an annual report on 41
the incidence and prevalence of Lyme disease in Missouri, 42
including, but not limited to, demographic data, geographic 43
distribution, treatment outcomes, and barriers to care. The 44
department shall submit the report to the CDC and the 45
general assembly and make such report available to the 46
public on the department's website by no later than December 47
thirty-first of each year. 48
5. The department shall collaborate with the 49
University of Missouri or any public four-year institution 50
of higher education to integrate Lyme disease surveillance 51
data into existing tick-borne disease monitoring programs. 52
6. Any information collected or reported under this 53
section shall be done in a manner that protects individually 54
identifiable or potentially identifiable information and 55
that is consistent with state and federal privacy laws. 56
7. The department may promulgate any rules and 57
regulations necessary to implement the provisions of this 58
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section and section 192.027. Any rule or portion of a rule, 59
as that term is defined in section 536.010, that is created 60
under the authority delegated in this section shall become 61
effective only if it complies with and is subject to all of 62
the provisions of chapter 536 and, if applicable, section 63
536.028. This section and chapter 536 are nonseverable and 64
if any of the powers vested with the general assembly 65
pursuant to chapter 536 to review, to delay the effective 66
date, or to disapprove and annul a rule are subsequently 67
held unconstitutional, then the grant of rulemaking 68
authority and any rule proposed or adopted after August 28, 69
2026, shall be invalid and void. 70
192.027. 1. There is hereby created in the state 1
treasury the "Lyme Research and Eradication Fund", which 2
shall consist of moneys appropriated to it by the general 3
assembly, as well as any grants, bequests, gifts, or 4
donations. The state treasurer shall be custodian of the 5
fund. In accordance with sections 30.170 and 30.180, the 6
state treasurer may approve disbursements. The fund shall 7
be a dedicated fund and money in the fund shall be used 8
solely by the department for the purposes of implementing 9
the provisions of this section. Notwithstanding the 10
provisions of section 33.080 to the contrary, any moneys 11
remaining in the fund at the end of the biennium shall not 12
revert to the credit of the general revenue fund. The state 13
treasurer shall invest moneys in the fund in the same manner 14
as other funds are invested. Any interest and moneys earned 15
on such investments shall be credited to the fund. 16
2. The department shall use the moneys in the fund to 17
distribute grants to public four-year institutions of higher 18
education, research institutions, and nonprofit 19
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organizations for Lyme disease research, including, but not 20
limited to, the following: 21
(1) Development of improved diagnostics, therapies, 22
and treatments; 23
(2) Studies on novel therapies, such as those inspired 24
by natural host immunity; and 25
(3) Eradication strategies, including, but not limited 26
to, tick population control through acaricides, deer 27
management programs, and environmental interventions. 28
3. The department shall prioritize grants based on 29
insurance claims data reported under subsection 5 of section 30
376.1223, with an emphasis on high incidence areas and 31
underserved populations. No less than twenty percent of the 32
funds shall be utilized to support eradication efforts in 33
rural counties. 34
4. The department shall submit a report to the general 35
assembly no later than March first of each year detailing 36
fund expenditures, research outcomes, and progress toward 37
Lyme disease eradication in the state. 38
192.028. Notwithstanding any provision of law to the 1
contrary, a health care provider shall not be subject to any 2
discipline, suspension or revocation of a license, or denial 3
of a license renewal solely for, within such provider's 4
scope of practice, prescribing, administering, or dispensing 5
treatments or therapies for Lyme disease or posttreatment 6
Lyme disease syndrome, including, but not limited to, 7
extended antibiotic therapy or similar treatment deemed 8
medically necessary. 9
376.1223. 1. As used in this section, the terms 1
"health carrier" and "health benefit plan" shall have the 2
same meanings as given to the terms under section 376.1350 3
and the terms "Lyme disease", "medically necessary", and 4
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"posttreatment Lyme disease syndrome" shall have the same 5
meanings as given to the terms under section 192.026. 6
2. Every health carrier or health benefit plan that 7
offers or issues health benefit plans that are delivered, 8
issued for delivery, continued, or renewed in this state on 9
or after January 1, 2027, shall, at a minimum, provide 10
coverage for diagnostic testing, treatment, and management 11
of Lyme disease and posttreatment Lyme disease syndrome for 12
insured persons who receive a diagnosis from a licensed 13
health care provider acting within the scope of his or her 14
practice, including, but not limited to, the following when 15
deemed as medically necessary by the treating provider: 16
(1) Serologic testing, immunofluorescence antibody 17
testing, immunity testing, C6 Lyme enzyme immunoassay 18
testing, or other similar blood tests and clinical 19
evaluations conducted according to guidelines issued by the 20
federal Centers for Disease Control and Prevention; 21
(2) Antibiotic therapy, including oral and intravenous 22
antibiotics, for a minimum of twenty-eight days for acute 23
Lyme disease and ninety days or longer for posttreatment 24
Lyme disease syndrome; 25
(3) Supportive therapies, including, but not limited 26
to, intravenous immunoglobulin, pain management, and 27
cognitive rehabilitation; and 28
(4) Holistic or herbal supplements and therapies. 29
3. The coverage described in subsection 2 of this 30
section shall be subject to the same deductibles, 31
coinsurance, and out-of-pocket maximums as apply to other 32
services covered under the health benefit plan for 33
nonpreventative services. No health carrier or health 34
benefit plan shall require prior authorization for any 35
testing, antibiotic therapy, or herbal therapy, but may 36
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require prior authorization for other medically necessary 37
services. 38
4. A health carrier or health benefit plan shall not: 39
(1) Deny or limit coverage for Lyme disease tests or 40
treatments based solely on guidelines issued by the 41
Infectious Disease Society of America that deem extended 42
antibiotic therapy to be experimental; 43
(2) Impose step therapy or fail-first requirements for 44
Lyme disease treatments that differ from those required for 45
similar infectious or chronic conditions; and 46
(3) Rescind coverage retroactively for Lyme disease- 47
related claims without evidence of fraud. 48
5. By July first of every year, each health carrier 49
and health benefit plan shall report to the director of the 50
department of commerce and insurance the number of Lyme 51
disease claims processed, denial rates, average duration of 52
treatment, and total expenditures for Lyme disease-related 53
care. The director shall compile and submit this data to 54
the general assembly and the department of health and senior 55
services to inform research priorities. 56
6. The provisions of this section shall not apply to a 57
supplemental insurance policy, including a life care 58
contract, accident-only policy, specified disease policy, 59
hospital policy providing a fixed daily benefit only, 60
Medicare supplement policy, long-term care policy, short- 61
term major medical policies of six months' or less duration, 62
or any other supplemental policy as determined by the 63
director of the department of commerce and insurance. 64
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