Text: SSB02087 Text: SSB02089 Text: SSB02000 - SSB02099 Text: SSB 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 cost
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 prescribed by a licensed health care
1 10 provider authorized to prescribe such items. Such items shall
1 11 include all of the following:
1 12 (1) 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 (2) Medications to control blood sugar levels including
1 16 insulin and oral agents.
1 17 (3) Equipment and supplies necessary for insulin
1 18 administration including syringes, insulin pumps, infusion
1 19 set, and insulin pens.
1 20 (4) Assistive devices for the visually impaired including
1 21 voice modulated blood glucose meters and injection aids.
1 22 (5) Podiatric appliances for prevention of complications
1 23 associated with diabetes.
1 24 (6) Podiatric health care provider services as are deemed
1 25 medically necessary to prevent complications from diabetes.
1 26 (7) 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 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 (8) 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 examiners.
2 8 b. The coverage requirement of paragraph "a" shall only
2 9 apply to diabetes outpatient self-management training and
2 10 education provided by a licensed health care provider with
2 11 expertise in treating diabetes.
2 12 2. The commissioner, based upon reasonable evidence as to
2 13 cost-effectiveness, may by rule include additional services,
2 14 equipment, and supplies in the coverage requirement of this
2 15 section. The commissioner shall by rule include additional
2 16 services, equipment, and supplies approved by the United
2 17 States food and drug administration in the coverage
2 18 requirement of this section.
2 19 3. This section applies to the following classes of third-
2 20 party payment provider contracts or policies delivered, issued
2 21 for delivery, continued, or renewed in this state on or after
2 22 July 1, 1998:
2 23 a. Individual or group accident and sickness insurance
2 24 providing coverage on an expense-incurred basis.
2 25 b. An individual or group hospital or medical service
2 26 contract issued pursuant to chapter 509, 514, or 514A.
2 27 c. An individual or group health maintenance organization
2 28 contract regulated under chapter 514B.
2 29 d. An individual or group Medicare supplemental policy,
2 30 unless coverage pursuant to such policy is preempted by
2 31 federal law.
2 32 e. Any other entity engaged in the business of insurance,
2 33 risk transfer, or risk retention, which is subject to the
2 34 jurisdiction of the commissioner.
2 35 f. A plan established pursuant to chapter 509A for public
3 1 employees.
3 2 g. An organized delivery system licensed by the director
3 3 of public health.
3 4 EXPLANATION
3 5 This bill provides that a third-party payor of health or
3 6 medical expenses shall provide coverage benefits to an insured
3 7 or enrollee for the cost associated with equipment, supplies,
3 8 and self-management training and education for the treatment
3 9 of all types of diabetes mellitus, impaired glucose tolerance,
3 10 and impaired fasting glucose when prescribed by a licensed
3 11 health care provider authorized to prescribe such items. The
3 12 bill identifies certain services, equipment, and supplies for
3 13 which coverage is required, grants authority to the insurance
3 14 commissioner to include by rule additional services,
3 15 equipment, and supplies in the coverage required in this
3 16 section, and requires the commissioner to include additional
3 17 services, equipment, and supplies approved by the United
3 18 States food and drug administration.
3 19 The bill provides that the section applies to third-party
3 20 payor contracts or policies delivered, issued for delivery,
3 21 continued, or renewed in this state on or after July 1, 1998,
3 22 by an individual or group accident and sickness insurance
3 23 providing coverage on an expense-incurred basis; an individual
3 24 or group hospital or medical service contract issued pursuant
3 25 to Code chapter 509, 514, or 514A; an individual or group
3 26 health maintenance organization contract regulated under Code
3 27 chapter 514B; an individual or group Medicare supplemental
3 28 policy, unless coverage pursuant to such policy is preempted
3 29 by federal law; any other entity engaged in the business of
3 30 insurance, risk transfer, or risk retention, which is subject
3 31 to the jurisdiction of the commissioner; a plan established
3 32 pursuant to Code chapter 509A for public employees; and an
3 33 organized delivery system licensed by the director of public
3 34 health.
3 35 LSB 3702SC 77
4 1 mj/cf/24
Text: SSB02087 Text: SSB02089 Text: SSB02000 - SSB02099 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
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