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HB 1268

Health Insurance - Lyme Disease and Related Tick-Borne Illnesses - Long-Term Antibiotic Treatment

2025 Regular Session Introduced by Jason Buckel and 4 co-sponsors

Requires Maryland health carriers to cover the full length of physician‑ordered long‑term antibiotic treatment for Lyme and related tick‑borne illnesses, not limited by “unproven”

Hearing 3/11 at 2:45 p.m.
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Bill Summary · HB 1268

Summary — HB 1268

Health Insurance — Lyme Disease and Related Tick‑Borne Illnesses — Long‑Term Antibiotic Treatment

Status: Hearing scheduled 3/11 at 2:45 p.m.
Introduced: November 13, 2024 (First Reader March 7, 2025)
If enacted: takes effect January 1, 2026; applies to policies issued, delivered, or renewed on or after that date.

Purpose / Intent

Require Maryland health carriers to cover physician‑prescribed long‑term antibiotic treatment for Lyme disease and certain related tick‑borne illnesses, and to prevent carriers from denying or limiting such coverage solely because the treatment is considered “unproven,” “experimental,” or “investigational.”

Key provisions

  • Definitions
    • “Long‑term antibiotic treatment”: oral, intramuscular, or intravenous antibiotic therapy administered for longer than four weeks.
    • “Lyme disease”: broad definition that includes clinical diagnoses by a licensed physician (acute, late‑stage, persistent/chronic, complications), infections meeting CDC surveillance criteria, infections by other Borrelia strains recognized by CDC, and clinical diagnoses that do not meet surveillance criteria but present compatible signs/symptoms.
    • “Related tick‑borne illnesses”: bartonellosis, babesiosis, ehrlichiosis, anaplasmosis, piroplasmosis, and other tick‑borne illnesses that may be associated with Lyme disease.
  • Coverage requirements
    • Carriers (insurers, nonprofit health service plans, HMOs providing hospital/medical/surgical/pharmaceutical benefits in Maryland) must cover the full length of long‑term antibiotic treatment when ordered by a licensed treating physician for therapeutic purposes and administered as prescribed.
    • Carriers may not impose a quantitative limitation on the long‑term antibiotic treatment required under the bill.
    • Carriers may not deny coverage for otherwise eligible treatment solely because it is categorized as unproven, experimental, or investigational.

Who would be affected

  • Directly: Health insurers, nonprofit health service plans, and HMOs operating in Maryland that issue policies delivering hospital/medical/surgical/pharmaceutical benefits.
  • Beneficiaries: Enrollees who receive physician‑ordered long‑term antibiotic therapy for Lyme disease or specified related tick‑borne illnesses.
  • Employers / local governments: Local governments that purchase fully insured medical plans could see increased premium or plan costs if carriers’ costs rise. The fiscal note states no impact on the Maryland State Employee and Retiree Health and Welfare Benefits Program.
  • Small businesses: Fiscal note indicates no small business effect.

Fiscal and administrative impact

  • Maryland Insurance Administration (MIA): minimal increase in special fund revenue in FY2026 from a $125 rate/form filing fee; MIA can likely review form filings with existing resources.
  • State: No projected fiscal impact on the State Employee health program per the fiscal note.
  • ACA consideration: MIA advises the bill would create a mandated benefit for the large‑group market and individual grandfathered market. Under the federal ACA, if the state mandates benefits that extend beyond the federal Essential Health Benefits (EHBs) for individual and small‑group plans sold through the exchange, the State must defray the cost of that mandate for exchange plans. The fiscal note warns of potential state liability if the mandate is applied to ACA plans.

Other notes

  • Similar proposals have been introduced in prior sessions (e.g., HB 1351 of 2024, HB 1199 of 2023, HB 1244 of 2022).
  • Sponsors listed in the bill text include Delegates Howard, Buckel, Hornberger, Miller, and Reilly (as introduced).

If you want, I can prepare:
- A one‑page handout focusing on carrier compliance obligations and practical implications for patients and providers; or
- A short list of likely stakeholder positions (insurers, patient advocacy groups, state officials) based on the bill’s provisions.

Compiled from official sources — confirm details with the bill’s official record.

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