2023 -- H 5281

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LC001061

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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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:

     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, 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.

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

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

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

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

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

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

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

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

person has met their plan's deductible.

     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,

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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 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.

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

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

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

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

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

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

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

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

person has met their plan's deductible.

     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:

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     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,

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

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.

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

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

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

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

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

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

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

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

person has met their plan's deductible.

     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, 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 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

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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.

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

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

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

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

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

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

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

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

person has met their plan's deductible.

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

amended by adding thereto the following section:

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

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

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

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

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

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

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

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

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

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

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

deductible.

     SECTION 6. This act shall take effect upon passage.

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

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

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

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

commence on January 1, 2024.

     This act would take effect upon passage.

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