§36-6060.2. Treatment of diabetes - Equipment, supplies and

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services.

A. 1. Every health benefit plan issued or renewed on or after November 1, 1996, shall, subject to the terms of the policy contract or agreement, include coverage for the following equipment, supplies and related services for the treatment of Type I, Type II, and gestational diabetes, when medically necessary and when recommended or prescribed by a physician or other licensed health care provider legally authorized to prescribe under the laws of this state:

a. blood glucose monitors,

b. blood glucose monitors to the legally blind,

c. test strips for glucose monitors,

d. visual reading and urine testing strips,

insulin,

injection aids,

cartridges for the legally blind,

syringes,

insulin pumps and appurtenances thereto,

insulin infusion devices,

oral agents for controlling blood sugar, and

podiatric appliances for prevention of complications

associated with diabetes.

2. The State Board of Health shall develop and annually update, by rule, a list of additional diabetes equipment, related supplies and health care provider services that are medically necessary for the treatment of diabetes, for which coverage shall also be included, subject to the terms of the policy, contract, or agreement, if the equipment and supplies have been approved by the federal Food and Drug Administration (FDA). Additional FDA-approved diabetes equipment and related supplies, and health care provider services shall be determined in consultation with a national diabetes association affiliated with this state, and at least three

(3)medical directors of health benefit plans, to be selected by the State Department of Health.

3. All policies specified in this section shall also include coverage for:

a. podiatric health care provider services as are deemed

medically necessary to prevent complications from

diabetes, and

b. diabetes self-management training. As used in this

subparagraph, "diabetes self-management training"

means instruction in an inpatient or outpatient

setting which enables diabetic patients to understand

the diabetic management process and daily management

of diabetic therapy as a method of avoiding frequent

hospitalizations and complications. Diabetes self-

management training shall comply with standards

developed by the State Board of Health in consultation

with a national diabetes association affiliated with

this state and at least three medical directors of

health benefit plans selected by the State Department

of Health. Coverage for diabetes self-management

training, including medical nutrition therapy relating

to diet, caloric intake, and diabetes management, but

excluding programs the only purpose of which are

weight reduction, shall be limited to the following:

(1)visits medically necessary upon the diagnosis of

diabetes,

(2)a physician diagnosis which represents a

significant change in the symptoms or condition

of the patient making medically necessary changes

in the self-management of the patient, and

(3)visits when reeducation or refresher training is

medically necessary; provided, however, payment for the coverage required for diabetes self-management training pursuant to the provisions of this section shall be required only upon certification by the health care provider providing the training that the patient has successfully completed diabetes self-management training.

4. Diabetes self-management training shall be supervised by a licensed physician or other licensed health care provider legally authorized to prescribe under the laws of this state. Diabetes self-management training may be provided by the physician or other appropriately registered, certified, or licensed health care professional as part of an office visit for diabetes diagnosis or treatment. Training provided by appropriately registered, certified, or licensed health care professionals may be provided in group settings where practicable.

5. Coverage for diabetes self-management training and training related to medical nutrition therapy, when provided by a registered, certified, or licensed health care professional, shall also include home visits when medically necessary and shall include instruction in medical nutrition therapy only by a licensed registered dietician or licensed certified nutritionist when authorized by the supervising physician of the patient when medically necessary.

6. Coverage may be subject to the same annual deductibles or coinsurance as may be deemed appropriate and as are consistent with those established for other covered benefits within a given policy.

7. Any health benefit plan, as defined pursuant to Section 6060.4 of this title, that provides coverage for insulin pursuant to this section shall cap the total amount that a covered person is required to pay for insulin at an amount not to exceed Thirty Dollars ($30.00) per thirty-day supply or Ninety Dollars ($90.00) per ninety-day supply of insulin for each covered insulin prescription, regardless of the amount or type of insulin needed to fill the prescription or prescriptions of the covered person.

a. Nothing in this paragraph shall prevent a health

benefit plan from reducing the cost-sharing of a

covered person to an amount less than Thirty Dollars

($30.00) per thirty-day supply or Ninety Dollars

($90.00) per ninety-day supply.

b. The Insurance Commissioner shall ensure all health

benefit plans comply with the requirements of this

paragraph.

c. The Commissioner may promulgate rules as necessary to

implement and administer the requirements of this

paragraph and to align with federal requirements.

B. 1. Health benefit plans shall not reduce or eliminate coverage due to the requirements of this section.

2. Enforcement of the provisions of this act shall be performed by the Insurance Department and the State Department of Health.

C. As used in this section, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of this title. Added by Laws 1996, c. 125, § 1, eff. Nov. 1, 1996. Amended by Laws 2010, c. 222, § 30, eff. Nov. 1, 2010; Laws 2021, c. 61, § 1, eff. Nov. 1, 2021; Laws 2022, c. 199, § 1, eff. Nov. 1, 2022.