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House File 2205

Partial Bill History

Bill Text

PAG LIN
  1  1    Section 1.  NEW SECTION.  514C.14  DIABETES COVERAGE.
  1  2    1.  a.  Notwithstanding the uniformity of treatment
  1  3 requirements of section 514C.6, a policy or contract providing
  1  4 for third-party payment or prepayment of health or medical
  1  5 expenses shall provide coverage benefits for the costs
  1  6 associated with equipment, supplies, and related services for
  1  7 the treatment of type I, type II, and gestational and
  1  8 secondary diabetes, impaired fasting glucose, and impaired
  1  9 glucose tolerance, when prescribed by a licensed health care
  1 10 provider authorized to prescribe such items, including the
  1 11 following:
  1 12    (1)  Blood glucose monitors, including necessary equipment
  1 13 and supplies.
  1 14    (2)  Blood glucose monitors for the visually impaired,
  1 15 including necessary equipment and supplies.
  1 16    (3)  Visual reading and urine test strips.
  1 17    (4)  Insulin.
  1 18    (5)  Injection aids.
  1 19    (6)  Cartridges for the legally blind.
  1 20    (7)  Syringes and needles, lancing devices, and lancets.
  1 21    (8)  Insulin pumps and necessary appurtenances to such
  1 22 pumps.
  1 23    (9)  Insulin infusion devices.
  1 24    (10)  Oral and injectable agents for treating and
  1 25 controlling blood sugar levels.
  1 26    (11)  Podiatric appliances for prevention of complications
  1 27 associated with diabetes.
  1 28    b.  A policy or contract under this section shall also
  1 29 provide coverage for the following:
  1 30    (1)  Podiatric health care provider services as are deemed
  1 31 medically necessary to prevent complications from diabetes.
  1 32    (2)  Diabetes self-management training, including medically
  1 33 necessary inpatient or outpatient instruction and training
  1 34 which enables a diabetic patient to understand the diabetic
  1 35 management process and daily management of diabetic therapy.
  2  1    (3)  Diabetes self-management education provided by a
  2  2 licensed dietician registered by the American diabetic
  2  3 association, a health care provider certified by the national
  2  4 certification board of diabetes educators as a certified
  2  5 diabetes educator, a registered nurse providing education in
  2  6 connection with a diabetes education program certified by the
  2  7 American diabetes association or the state, or a licensed
  2  8 pharmacist qualified with regard to diabetes management and
  2  9 education by institutions recognized by the board of pharmacy.
  2 10    2.  The commissioner, based upon reasonable evidence as to
  2 11 cost-effectiveness, shall by rule develop and annually update
  2 12 a list of additional health care provider services, equipment,
  2 13 and supplies to be covered under the coverage required in this
  2 14 section.  Additional equipment and supplies to be included by
  2 15 rule of the commissioner must be approved by the federal food
  2 16 and drug administration.  Additional health care provider
  2 17 services shall be determined in consultation with the Iowa
  2 18 department of public health and a minimum of three medical
  2 19 directors associated with health benefit plans as selected by
  2 20 the department.
  2 21    3.  This section applies to the following classes of third-
  2 22 party payment provider contracts or policies delivered, issued
  2 23 for delivery, continued, or renewed in this state on or after
  2 24 July 1, 1998:
  2 25    a.  Individual or group accident and sickness insurance
  2 26 providing coverage on an expense-incurred basis.
  2 27    b.  An individual or group hospital or medical service
  2 28 contract issued pursuant to chapter 509, 514, or 514A.
  2 29    c.  An individual or group health maintenance organization
  2 30 contract regulated under chapter 514B.
  2 31    d.  An individual or group Medicare supplemental policy,
  2 32 unless coverage pursuant to such policy is preempted by
  2 33 federal law.
  2 34    e.  Any other entity engaged in the business of insurance,
  2 35 risk transfer, or risk retention, which is subject to the
  3  1 jurisdiction of the commissioner.
  3  2    f.  A plan established pursuant to chapter 509A for public
  3  3 employees.
  3  4    g.  An organized delivery system licensed by the director
  3  5 of public health.  
  3  6                           EXPLANATION
  3  7    This bill provides that a third-party payor of health or
  3  8 medical expenses shall provide coverage benefits to an insured
  3  9 or enrollee for the costs associated with equipment, supplies,
  3 10 and self-management training and education for the treatment
  3 11 of type I, type II, and gestational and secondary diabetes,
  3 12 impaired fasting glucose, and impaired glucose tolerance when
  3 13 prescribed by a licensed health care provider authorized to
  3 14 prescribe such items.  The bill identifies certain services,
  3 15 equipment, and supplies for which coverage is provided and
  3 16 grants authority to the insurance commissioner to include by
  3 17 rule additional services, equipment, and supplies in the
  3 18 coverage required in this section.
  3 19    The bill provides that the new Code section applies to
  3 20 third-party payor contracts or policies delivered, issued for
  3 21 delivery, continued, or renewed in this state on or after July
  3 22 1, 1998, by an individual or group accident and sickness
  3 23 insurance policy providing coverage on an expense-incurred
  3 24 basis; an individual or group hospital or medical service
  3 25 contract issued pursuant to Code chapter 509, 514, or 514A; an
  3 26 individual or group health maintenance organization contract
  3 27 regulated under Code chapter 514B; an individual or group
  3 28 Medicare supplemental policy, unless coverage pursuant to such
  3 29 policy is preempted by federal law; any other entity engaged
  3 30 in the business of insurance, risk transfer, or risk
  3 31 retention, which is subject to the jurisdiction of the
  3 32 commissioner; a plan established pursuant to Code chapter 509A
  3 33 for public employees; and an organized delivery system
  3 34 licensed by the director of public health.  
  3 35 LSB 3545HH 77
  4  1 mj/jl/8
     

Text: HF02204                           Text: HF02206
Text: HF02200 - HF02299                 Text: HF Index
Bills and Amendments: General Index     Bill History: General Index

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