HEALTH INSURANCE; DISEASES;
DISEASES;
Connecticut laws/regulations;
July 29, 2003 |
2003-R-0563 | |
LYME DISEASE | ||
| ||
By: John Kasprak, Senior Attorney | ||
You asked for (1) the number of reported Lyme disease cases in Connecticut and (2) whether insurance coverage for treatment of Lyme disease is mandated in Connecticut and other states.
LYME DISEASE CASES
In 2002, Connecticut reported 4,631 cases of Lyme disease. The state’s rate of 136 cases per 100,000 population was the highest reported rate of any state. Windham County reported the highest rate with 447. 3 cases per 100,000 population. Hartford County had the lowest rate at 34. 2 per 100,000 population. The second highest rate was found in Litchfield County (371. 6 per 100,000).
Table 1 provides statistics on reported Lyme disease cases and rates per 100,000 population in the state for the period 1991 to 2002.
Table 1-Connecticut Lyme Disease Cases and Rates
Per 100,000 Population (1991-2002)
Year |
Cases |
Rate Per 100,000 Population |
2002 |
4,631 |
136 |
2001 |
3,597 |
105. 6 |
2000 |
3,773 |
110. 8 |
1999 |
3,213 |
97. 7 |
Table 1 (Continued)
Year |
Cases |
Rate Per 100,000 Population |
1998 |
3,434 |
104. 5 |
1997 |
2,297 |
69. 9 |
1996 |
3,104 |
94. 4 |
1995 |
1,548 |
47. 1 |
1994 |
2,030 |
61. 8 |
1993 |
1,350 |
41. 1 |
1992 |
1,760 |
53. 5 |
1991 |
1,192 |
36. 3 |
Source: Connecticut Department of Public Health, Epidemiology Program
HEALTH INSURANCE COVERAGE
Connecticut
Public Act 99-284 (the “managed care reform act”) requires individual and group health insurance policies to cover Lyme disease treatment including at least 30 days of intravenous antibiotic therapy, 60 days of oral antibiotic therapy, or both. Such policies must provide further treatment if recommended by a board-certified rheumatologist, infectious disease specialist, or neurologist licensed in the state. Subsequently, PA 99-2, June Special Session, specified that the rheumatologist, infectious disease specialist, or neurologist could be licensed in another state with practice requirements substantially similar to Connecticut’s. (see CGS §§ 38a-492h; 38-518h).
This coverage requirement applies to hospital and medical services offered by HMOs and health insurance policies that cover (1) basic hospital expenses, (2) basic medical-surgical expenses, (3) major medical expenses, or (4) hospital or medical service expenses. The coverage must be in plans delivered, issued for delivery, renewed, or continued in the state beginning January 1, 2000.
Other States
As best as we can determine, Minnesota and Rhode Island also mandate health insurance coverage for Lyme disease treatment. Minnesota’s law specifies “every health plan must cover treatment for diagnosed Lyme disease” (Minnesota Statutes, § 62A. 265).
Rhode Island recently passed legislation mandating coverage for certain Lyme disease treatments (Chapter 113 of the Rhode Island Laws; enacted July 7, 2003). This new law states, “every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan delivered, issued for delivery, or renewed in this state on or after January 1, 2004 shall 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 after making a thorough evaluation of the patient’s symptoms, diagnostic test results and response to treatment. ” The law also specifies “treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature. ”
Generally, states without Lyme disease coverage mandates leave coverage up to individual health insurers, which can result in varying degrees of coverage.
JK: ts