SENATE HEALTH COMMITTEE

 

STATEMENT TO

 

SENATE, No. 297

 

STATE OF NEW JERSEY

 

DATED: JUNE 20, 1996

 

      The Senate Health Committee reports favorably Senate Bill No.297.

      This bill requires individual, small employer and large group health insurers, including hospital, medical and health service corporations, commercial insurers and health maintenance organizations, to provide benefits for the treatment of Lyme disease, including intravenous therapy, when diagnosed and determined to be medically necessary by the covered person's physician, after making a written evaluation of that person's symptoms, condition and response to treatment.

      On or after the 56th day of benefits for intravenous therapy for the treatment of Lyme disease, a health insurer may require the insured to be examined by a second physician to determine whether further benefits for intravenous therapy are medically necessary. The physician must be randomly selected from a Lyme Disease Referral List prepared by the Department of Health pursuant to specific criteria in the bill. If, after an examination, the second physician determines that further benefits for intravenous therapy are not medically necessary, the health insurer may deny benefits for intravenous therapy on or after the fifth day following the determination.

      Treatment otherwise eligible for benefits pursuant to this bill shall not be denied because such treatment could be characterized as experimental or investigational in nature.

      This bill was prefiled for introduction in the 1996-97 session pending technical review. As reported, the bill includes the changes required by technical review which has been performed.