2023 -- H 5281

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LC001061

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Kennedy, Kazarian, Edwards, Diaz, Azzinaro, Serpa,
Morales, McEntee, Ackerman, and O'Brien

     Date Introduced: February 01, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

1

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

2

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

3

     27-18-38. Diabetes treatment.

4

     (a) Every individual or group health insurance contract, plan, or policy delivered, issued

5

for delivery or renewed in this state which provides medical coverage that includes coverage for

6

physician services in a physician’s office, and every policy which provides major medical or similar

7

comprehensive-type coverage, except for supplemental policies which only provide coverage for

8

specified diseases and other supplemental policies, shall include coverage for the following

9

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

10

and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose

11

monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or

12

visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and

13

appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar

14

and therapeutic/molded shoes for the prevention of amputation.

15

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

16

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

17

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

18

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

19

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

 

1

of their diabetes, including information on the nutritional management of diabetes. The coverage

2

for self-management education and education relating to medical nutrition therapy shall be limited

3

to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a

4

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

5

self-management, or where reeducation or refresher training is necessary. This education when

6

medically necessary and prescribed by a physician, may be provided only by the physician or, upon

7

his or her referral to an appropriately licensed and certified health care provider and may be

8

conducted in group settings. Coverage for self-management education and education relating to

9

medical nutrition therapy shall also include home visits when medically necessary.

10

     (c) Benefit plans offered by an insurer may impose co-payment and/or deductibles for the

11

benefits mandated by this chapter; however, in no instance shall the co-payment or deductible

12

amount be greater than the co-payment or deductible amount imposed for other supplies, equipment

13

or physician office visits. Benefits for services under this section shall be reimbursed in accordance

14

with the respective principles and mechanisms of reimbursement for each insurer, hospital, or

15

medical service corporation, or health maintenance organization.

16

     (d) Commencing January 1, 2024, coverage for equipment and supplies for insulin

17

administration and glucose monitoring shall have a cap on the amount that a covered person is

18

required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a

19

supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty

20

(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible.

21

If the application of the cap to a specific item of equipment or supply before a covered person has

22

met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. §

23

223, then the cap would only apply to that specific item of equipment or supply after the covered

24

person has met their plan's deductible.

25

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

26

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

27

     27-19-35. Diabetes treatment.

28

     (a) Every individual or group health insurance contract, plan, or policy delivered, issued

29

for delivery or renewed in this state which provides medical coverage that includes coverage for

30

physician services in a physician’s office, and every policy which provides major medical or similar

31

comprehensive-type coverage, shall include coverage for the following equipment and supplies for

32

the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when

33

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

34

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

 

LC001061 - Page 2 of 7

1

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

2

pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

where a physician diagnosis a significant change in the patient’s symptoms or conditions which

12

necessitate changes in a patient’s self-management, or where reeducation or refresher training is

13

necessary. This education, when medically necessary and prescribed by a physician, may be

14

provided only by the physician or upon his or her referral by an appropriately licensed and certified

15

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

16

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

17

medically necessary.

18

     (b) Benefit plans offered by a hospital service corporation may impose copayment and/or

19

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

20

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

21

supplies, equipment, or physician office visits. Benefits for services under this chapter shall be

22

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

23

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

24

     (c) Commencing January 1, 2024, coverage for equipment and supplies for insulin

25

administration and glucose monitoring shall have a cap on the amount that a covered person is

26

required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a

27

supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty

28

(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible.

29

If the application of the cap to a specific item of equipment or supply before a covered person has

30

met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. §

31

223, then the cap would only apply to that specific item of equipment or supply after the covered

32

person has met their plan's deductible.

33

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

34

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

 

LC001061 - Page 3 of 7

1

     27-20-30. Diabetes treatment.

2

     (a) Every individual or group health insurance contract, plan, or policy delivered, issued

3

for delivery or renewed in this state which provides medical coverage that includes coverage for

4

physician services in a physician’s office, and every policy which provides major medical or similar

5

comprehensive-type coverage, shall include coverage for the following equipment and supplies for

6

the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when

7

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

8

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

9

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

10

pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

visits when medically necessary.

26

     (b) Benefit plans offered by a hospital service corporation may impose copayment and/or

27

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

28

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

29

supplies, equipment, or physician office visits. Benefits for services under this chapter shall be

30

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

31

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

32

     (c) Commencing January 1, 2024, coverage for equipment and supplies for insulin

33

administration and glucose monitoring shall have a cap on the amount that a covered person is

34

required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a

 

LC001061 - Page 4 of 7

1

supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty

2

(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible.

3

If the application of the cap to a specific item of equipment or supply before a covered person has

4

met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. §

5

223, then the cap would only apply to that specific item of equipment or supply after the covered

6

person has met their plan's deductible.

7

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

8

Maintenance Organizations" is hereby amended to read as follows:

9

     27-41-44. Diabetes treatment.

10

     (a) Every individual or group health insurance contract, plan, or policy delivered, issued

11

for delivery or renewed in this state which provides medical coverage that includes coverage for

12

physician services in a physician’s office and every policy which provides major medical or similar

13

comprehensive-type coverage shall include coverage for the following equipment and supplies for

14

the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when

15

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

16

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

17

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

18

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

19

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

20

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

21

coverage of this new diabetes equipment and supplies when medically appropriate and prescribed

22

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

23

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

24

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

25

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

26

nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where

27

a physician diagnoses a significant change in the patient’s symptoms or conditions which

28

necessitate changes in a patient’s self-management, or where reeducation or refresher training is

29

necessary. This education, when medically necessary and prescribed by a physician, may be

30

provided only by the physician or, upon his or her referral to an appropriately licensed and certified

31

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

32

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

33

medically necessary.

34

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

 

LC001061 - Page 5 of 7

1

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

2

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

3

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

4

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

5

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

6

     (c) Commencing January 1, 2024, coverage for equipment and supplies for insulin

7

administration and glucose monitoring shall have a cap on the amount that a covered person is

8

required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a

9

supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty

10

(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible.

11

If the application of the cap to a specific item of equipment or supply before a covered person has

12

met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. §

13

223, then the cap would only apply to that specific item of equipment or supply after the covered

14

person has met their plan's deductible.

15

     SECTION 5. Chapter 36-12 of the General Laws entitled "Insurance Benefits" is hereby

16

amended by adding thereto the following section:

17

     36-12-2.6. Health insurance benefits - Diabetes treatment.

18

     Commencing when the next health insurance plan for employees of the state of Rhode

19

Island is purchased or renewed by the director of administration pursuant to § 36-12-6, it shall be

20

required that coverage for equipment and supplies for insulin administration and glucose

21

monitoring shall have a cap on the amount that a covered person is required to pay for such

22

equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30)

23

days, or per item when an item is intended to be used for longer than thirty (30) days. Coverage for

24

such equipment and supplies shall not be subject to any annual deductible. If the application of the

25

cap to a specific item of equipment or supply before a covered person has met their plan's deductible

26

would result in health saving account ineligibility under 26 U.S.C. § 223, then the cap would only

27

apply to that specific item of equipment or supply after the covered person has met their plan's

28

deductible.

29

     SECTION 6. This act shall take effect upon passage.

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LC001061

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LC001061 - Page 6 of 7

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

     This act would cap the amount that a covered person is required to pay for insulin

2

administration and glucose monitoring equipment and supplies at twenty-five dollars ($25.00) per

3

thirty (30) day supply or per item when an item is intended to be used for longer than thirty (30)

4

days and would prohibit any deductible for the equipment and supplies. The coverage would

5

commence on January 1, 2024.

6

     This act would take effect upon passage.

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LC001061

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LC001061 - Page 7 of 7