2014 -- H 8166

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LC005504

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Naughton, E Coderre, Diaz, Slater, and Lombardi

     Date Introduced: May 08, 2014

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-38 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-38. Diabetes treatment. -- (a) Every individual or group health insurance contract,

plan, or policy delivered, issued for delivery or renewed in this state which provides medical

coverage that includes coverage for physician services in a physician's office, and every policy

which provides major medical or similar comprehensive-type coverage, except for supplemental

policies which only provide coverage for specified diseases and other supplemental policies, shall

include coverage for the following equipment and supplies for the treatment of insulin treated

diabetes, non-insulin treated diabetes, juvenile diabetes, and gestational diabetes, if medically

appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors

for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids,

cartridges for the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin

infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the

prevention of amputation.

      (b) Upon the approval of new or improved diabetes equipment and supplies by the Food

and Drug Administration, all policies governed by this section shall guarantee coverage of new

diabetes equipment and supplies when medically appropriate and prescribed by a physician.

These policies shall also include coverage, when medically necessary, for diabetes self-

management education to ensure that persons with diabetes are instructed in the self-management

and treatment of their diabetes, including information on the nutritional management of diabetes.

The coverage for self-management education and education relating to medical nutrition therapy

shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician

diagnoses a significant change in the patient's symptoms or conditions which necessitate changes

in a patient's self-management, or where reeducation or refresher training is necessary. This

education when medically necessary and prescribed by a physician, may be provided only by the

physician or, upon his or her referral to an appropriately licensed and certified health care

provider and may be conducted in group settings. Coverage for self-management education and

education relating to medical nutrition therapy shall also include home visits when medically

necessary.

      (c) Benefit plans offered by an insurer may impose minimum co-payment and/or no

deductibles for the benefits mandated by this chapter; however, in no instance shall the co-

payment or deductible amount be greater than the co-payment or deductible amount imposed for

other supplies, equipment or physician office visits. Benefits for services under this section shall

be reimbursed in accordance with the respective principles and mechanisms of reimbursement for

each insurer, hospital, or medical service corporation, or health maintenance organization.

     SECTION 2. Section 27-19-35 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-35. Diabetes treatment. -- (a) Every individual or group health insurance contract,

plan, or policy delivered, issued for delivery or renewed in this state which provides medical

coverage that includes coverage for physician services in a physician's office, and every policy

which provides major medical or similar comprehensive-type coverage, shall include coverage

for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin

treated diabetes, juvenile diabetes, and gestational diabetes when medically appropriate and

prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally

blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for

the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin infusion

devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the

prevention of amputation. Upon the approval of new or improved diabetes equipment and

supplies by the Food and Drug Administration, all policies governed by this chapter shall

guarantee coverage of new diabetes equipment and supplies when medically appropriate and

prescribed by a physician. The policies shall also include coverage, when medically necessary,

for diabetes self-management education to ensure that persons with diabetes are instructed in the

self-management and treatment of their diabetes, including information on the nutritional

LC005504 - Page 2 of 6

management of diabetes. The coverage for self-management education and education relating to

medical nutrition therapy shall be limited to medically necessary visits upon the diagnoses of

diabetes, where a physician diagnosis a significant change in the patient's symptoms or conditions

which necessitate changes in a patient's self-management, or where reeducation or refresher

training is necessary. This education, when medically necessary and prescribed by a physician,

may be provided only by the physician or upon his or her referral by an appropriately licensed

and certified health care provider and may be conducted in group settings. Coverage for self-

management education and education relating to medical nutrition therapy shall also include

home visits when medically necessary.

      (b) Benefit plans offered by an insurer may impose minimum co-payment and/or no

deductibles for the benefits mandated by this chapter; however, in no instance shall the co-

payment or deductible amount be greater than the co-payment or deductible amount imposed for

other supplies, equipment or physician office visits. Benefits for services under this section shall

be reimbursed in accordance with the respective principles and mechanisms of reimbursement for

each insurer, hospital, or medical service corporation, or health maintenance organization.

     SECTION 3. Section 27-20-30 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-30. Diabetes treatment. -- (a) Every individual or group health insurance contract,

plan, or policy delivered, issued for delivery or renewed in this state which provides medical

coverage that includes coverage for physician services in a physician's office, and every policy

which provides major medical or similar comprehensive-type coverage, shall include coverage

for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin

treated diabetes, juvenile diabetes, and gestational diabetes when medically appropriate and

prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally

blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for

the legally blind, syringes, insulin pumps, and appurtenances to the pumps, insulin infusion

devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the

prevention of amputation. Upon the approval of new or improved diabetes equipment and

supplies by the Food and Drug Administration, all policies governed by this chapter shall

guarantee coverage of new diabetes equipment and supplies when medically appropriate and

prescribed by a physician. These policies shall also include coverage, when medically necessary,

for diabetes self-management education to ensure that persons with diabetes are instructed in the

self-management and treatment of their diabetes, including information on the nutritional

management of diabetes. The coverage for self-management education and education relating to

LC005504 - Page 3 of 6

medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of

diabetes, where a physician diagnosis a significant change in the patient's symptoms or conditions

which necessitate changes in a patient's self-management, or where reeducation or refresher

training is necessary. This education, when medically necessary and prescribed by a physician,

may be provided only by the physician or, upon his or her referral, to an appropriately licensed

and certified health care provider, and may be conducted in group settings. Coverage for self-

management education and education relating to medical nutrition therapy shall also include

home visits when medically necessary.

      (b) Benefit plans offered by an insurer may impose minimum co-payment and/or no

deductibles for the benefits mandated by this chapter; however, in no instance shall the co-

payment or deductible amount be greater than the co-payment or deductible amount imposed for

other supplies, equipment or physician office visits. Benefits for services under this section shall

be reimbursed in accordance with the respective principles and mechanisms of reimbursement for

each insurer, hospital, or medical service corporation, or health maintenance organization.

     SECTION 4. Section 27-41-44 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-44. Diabetes treatment. -- (a) Every individual or group health insurance contract,

plan, or policy delivered, issued for delivery or renewed in this state which provides medical

coverage that includes coverage for physician services in a physician's office and every policy

which provides major medical or similar comprehensive-type coverage shall include coverage for

the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin

treated diabetes, juvenile diabetes, and gestational diabetes when medically appropriate and

prescribed by a physician blood glucose monitors and blood glucose monitors for the legally

blind, test strips for glucose monitors and visual reading, insulin, injection aids, cartridges for the

legally blind, syringes, insulin pumps and appurtenances to them, insulin infusion devices, oral

agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation.

Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug

Administration, all policies governed by this chapter shall guarantee coverage of this new

diabetes equipment and supplies when medically appropriate and prescribed by a physician.

These policies shall also include coverage, when medically necessary, for diabetes self-

management education to ensure that persons with diabetes are instructed in the self-management

and treatment of their diabetes, including information on the nutritional management of diabetes.

This coverage for self-management education and education relating to medical nutrition therapy

shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician

LC005504 - Page 4 of 6

diagnoses a significant change in the patient's symptoms or conditions which necessitate changes

in a patient's self-management, or where reeducation or refresher training is necessary. This

education, when medically necessary and prescribed by a physician, may be provided only by the

physician or, upon his or her referral to an appropriately licensed and certified health care

provider and may be conducted in group settings. Coverage for self-management education and

education relating to medical nutrition therapy shall also include home visits when medically

necessary.

      (b) Benefit plans offered by an insurer may impose minimum co-payment and/or no

deductibles for the benefits mandated by this chapter; however, in no instance shall the co-

payment or deductible amount be greater than the co-payment or deductible amount imposed for

other supplies, equipment or physician office visits. Benefits for services under this section shall

be reimbursed in accordance with the respective principles and mechanisms of reimbursement for

each insurer, hospital, or medical service corporation, or health maintenance organization.

     SECTION 5. This act shall take effect upon passage and shall apply to health insurance

contracts, plans, or policies delivered, issued or renewed on or after July 1, 2014.

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LC005504

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would add coverage for the treatment of juvenile diabetes to sickness insurance

policies, nonprofit hospital and medical service corporations, and health maintenance

organizations and apply to Medicaid recipients for policies issued or renewed on or after July 1,

2014.

     This act would take effect upon passage and would apply to health insurance contracts,

plans, or policies delivered, issued or renewed on or after July 1, 2014.

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LC005504

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