33-22-131. Coverage for treatment of inborn errors of metabolism.
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33-22-131 . Coverage for treatment of inborn errors of metabolism.
(1)Each group or individual medical expense disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for the treatment of inborn errors of metabolism that involve amino acid, carbohydrate, and fat metabolism and for which medically standard methods of diagnosis, treatment, and monitoring exist.
(2)Coverage must include expenses of diagnosing, monitoring, and controlling the disorders by nutritional and medical assessment, including but not limited to clinical services, biochemical analysis, medical supplies, prescription drugs, corrective lenses for conditions related to the inborn error of metabolism, nutritional management, and medical foods used in treatment to compensate for the metabolic abnormality and to maintain adequate nutritional status.
(3)For purposes of this section:
(a)"medical foods" means nutritional substances in any form that are:
(i)formulated to be consumed or administered enterally under supervision of a physician;
(ii)specifically processed or formulated to be distinct in one or more nutrients present in natural food;
(iii)intended for the medical and nutritional management of patients with limited capacity to metabolize ordinary foodstuffs or certain nutrients contained in ordinary foodstuffs or who have other specific nutrient requirements as established by medical evaluation; and
(iv)essential to optimize growth, health, and metabolic homeostasis;
(b)"treatment" means licensed professional medical services under the supervision of a physician.
(4)These services are subject to the terms of the applicable group or individual disability policy, certificate, or membership contract that establishes durational limits, dollar limits, deductibles, and copayment provisions as long as the terms are not less favorable than for physical illness generally.
(5)This section does not apply to disability income, hospital indemnity, medicare supplement, accident-only, vision, dental, or specified disease policies.