Text: HF00291 Text: HF00293 Text: HF00200 - HF00299 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 dietitian 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 included under the coverage required in
2 14 this section. Additional equipment and supplies to be
2 15 included by rule of the commissioner must be approved by the
2 16 federal food and drug administration. Additional health care
2 17 provider services shall be determined in consultation with the
2 18 Iowa department of public health and a minimum of three
2 19 medical directors associated with health benefit plans as
2 20 selected by 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, 1999:
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, 1999, 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 2269HH 78
4 1 mj/gg/8
Text: HF00291 Text: HF00293 Text: HF00200 - HF00299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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