2016 -- S 2896

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LC005607

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE - TYPE-1 DIABETES INSULIN

TREATMENT

     Introduced By: Senators Morgan, Pagliarini, Gee, Cote, and Lombardi

     Date Introduced: April 07, 2016

     Referred To: Senate Health & Human Services

     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, 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, including, without limitation,

all insulin medications used to control type-1 diabetes, 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 co-payment and/or 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, 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, including, without limitation, all insulin

medications used to control type-1 diabetes, 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

LC005607 - Page 2 of 6

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 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 a hospital service corporation may impose copayment and/or

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

copayment or deductible amount be greater than the copayment or deductible amount imposed for

other supplies, equipment, or physician office visits. Benefits for services under this chapter 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, 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, including, without limitation, all insulin

medications used to control type-1 diabetes, 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

LC005607 - Page 3 of 6

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 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 a hospital service corporation may impose copayment and/or

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

copayment or deductible amount be greater than the copayment or deductible amount imposed for

other supplies, equipment, or physician office visits. Benefits for services under this chapter 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, 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, including, without limitation, all insulin medications

used to control type-1 diabetes, 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-

LC005607 - Page 4 of 6

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.

      (b) Benefit plans offered by a health maintenance organization may impose copayment

and/or deductibles for the benefits mandated by this chapter. However, in no instance shall the

copayment or deductible amount be greater than the copayment or deductible amount imposed for

other supplies, equipment, or physician office visits. Benefits for services under this chapter 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 on January 1, 2017.

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LC005607

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - HEALTH INSURANCE - TYPE-1 DIABETES INSULIN

TREATMENT

***

     This act would require health insurance contracts, plans, and policies to provide coverage

for all insulin medications used to control type-1 diabetes.

     This act would take effect on January 1, 2017.

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LC005607

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