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