Text: HSB00600 Text: HSB00602 Text: HSB00600 - HSB00699 Text: HSB 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. 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 self-management
1 7 training and education for the treatment of all types of
1 8 diabetes mellitus, impaired glucose tolerance, and impaired
1 9 fasting glucose when such equipment, supplies, or training and
1 10 education is prescribed by a licensed health care provider
1 11 authorized to prescribe such items, including the following:
1 12 a. Equipment and supplies necessary for home monitoring
1 13 including blood glucose meter, glucose strips, finger sticking
1 14 devices, lancets, and urine testing strips.
1 15 b. Medications to control blood sugar levels including
1 16 insulin and oral agents.
1 17 c. Equipment and supplies necessary for insulin
1 18 administration including syringes, insulin pumps, infusion
1 19 set, and insulin pens.
1 20 d. Assistive devices for the visually impaired including
1 21 voice-modulated blood glucose meters and injection aids.
1 22 e. Podiatric appliances for prevention of complications
1 23 associated with diabetes.
1 24 f. Podiatric health care provider services as are deemed
1 25 medically necessary to prevent complications from diabetes.
1 26 g. Diabetes self-management training, including medically
1 27 necessary inpatient or outpatient instruction and training
1 28 under the direction of a physician licensed under chapter 148
1 29 or 150A, licensed physician's assistant, or a licensed nurse
1 30 practitioner which enables a diabetic patient to understand
1 31 the diabetic management process and daily management of
1 32 diabetic therapy.
1 33 h. Diabetes self-management education provided by a
1 34 licensed dietician registered by the American diabetic
1 35 association, a health care provider certified by the national
2 1 certification board of diabetes educators as a certified
2 2 diabetes educator, a registered nurse providing education in
2 3 connection with a diabetes education program certified by the
2 4 American diabetes association or the state, or a licensed
2 5 pharmacist qualified with regard to diabetes management and
2 6 education by institutions recognized by the board of pharmacy.
2 7 2. The commissioner, based upon reasonable evidence as to
2 8 cost-effectiveness, may by rule include additional services,
2 9 equipment, and supplies in the coverage required in this
2 10 section. The commissioner shall by rule include additional
2 11 services, equipment, and supplies approved by the federal food
2 12 and drug administration in the coverage required in this
2 13 section.
2 14 3. This section applies to the following classes of third-
2 15 party payment provider contracts or policies delivered, issued
2 16 for delivery, continued, or renewed in this state on or after
2 17 July 1, 1998:
2 18 a. Individual or group accident and sickness insurance
2 19 providing coverage on an expense-incurred basis.
2 20 b. An individual or group hospital or medical service
2 21 contract issued pursuant to chapter 509, 514, or 514A.
2 22 c. An individual or group health maintenance organization
2 23 contract regulated under chapter 514B.
2 24 d. An individual or group Medicare supplemental policy,
2 25 unless coverage pursuant to such policy is preempted by
2 26 federal law.
2 27 e. Any other entity engaged in the business of insurance,
2 28 risk transfer, or risk retention, which is subject to the
2 29 jurisdiction of the commissioner.
2 30 f. A plan established pursuant to chapter 509A for public
2 31 employees.
2 32 g. An organized delivery system licensed by the director
2 33 of public health.
2 34 EXPLANATION
2 35 This bill provides that a third-party payor of health or
3 1 medical expenses shall provide coverage benefits to an insured
3 2 or enrollee for the costs associated with equipment, supplies,
3 3 and self-management training and education for the treatment
3 4 of all types of diabetes mellitus, impaired glucose tolerance,
3 5 and impaired fasting glucose when prescribed by a licensed
3 6 health care provider authorized to prescribe such items. The
3 7 bill identifies certain services, equipment, and supplies for
3 8 which coverage is required and grants authority to the
3 9 insurance commissioner to include by rule additional services,
3 10 equipment, and supplies in the coverage required in this
3 11 section.
3 12 The bill provides that the new Code section applies to
3 13 third-party payor contracts or policies delivered, issued for
3 14 delivery, continued, or renewed in this state on or after July
3 15 1, 1998, by individual or group accident and sickness
3 16 insurance providing coverage on an expense-incurred basis; an
3 17 individual or group hospital or medical service contract
3 18 issued pursuant to Code chapter 509, 514, or 514A; an
3 19 individual or group health maintenance organization contract
3 20 regulated under Code chapter 514B; an individual or group
3 21 Medicare supplemental policy, unless coverage pursuant to such
3 22 policy is preempted by federal law; any other entity engaged
3 23 in the business of insurance, risk transfer, or risk
3 24 retention, which is subject to the jurisdiction of the
3 25 commissioner; a plan established pursuant to Code chapter 509A
3 26 for public employees; and an organized delivery system
3 27 licensed by the director of public health.
3 28 LSB 3778HC 77
3 29 mj/jl/8
Text: HSB00600 Text: HSB00602 Text: HSB00600 - HSB00699 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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