House File 478 - Enrolled




                                             HOUSE FILE 478

                             AN ACT
 RELATING TO HEALTH INSURANCE COVERAGE FOR DIABETES
    SELF=MANAGEMENT TRAINING AND EDUCATION PROGRAMS AND
    PROVIDING EFFECTIVE AND APPLICABILITY DATES.

 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 514C.18, Code 2009, is amended to read
 as follows:
    514C.18  DIABETES COVERAGE.
    1.  Notwithstanding the uniformity of treatment
 requirements of section 514C.6, a policy or contract providing
 for third=party payment or prepayment of health or medical
 expenses shall provide coverage benefits for the cost
 associated with equipment, supplies, and self=management
 training and education for the treatment of all types of
 diabetes mellitus when prescribed by a physician licensed
 under chapter 148.  Coverage benefits shall include coverage
 for the cost associated with all of the following:
    a.  Blood glucose meter and glucose strips for home
 monitoring.
    b.  Payment for diabetes self=management training and
 education only under all of the following conditions:
    (1)  The physician managing the individual's diabetic
 condition certifies that such services are needed under a
 comprehensive plan of care related to the individual's
 diabetic condition to ensure therapy compliance or to provide
 the individual with necessary skills and knowledge to
 participate in the management of the individual's condition.
    (2)  The diabetic diabetes self=management training and
 education program is certified by the Iowa department of
 public health.  The department shall consult with the American
 diabetes association, Iowa affiliate, in developing the
 standards for certification of diabetes education programs as
 follows:
    (a)  Initial training shall cover up to that cover at least
 ten hours of initial outpatient diabetes self=management
 training within a continuous twelve=month period and up to two
 hours of follow=up training for each subsequent year for each
 individual that meets any of the following conditions:
 diagnosed by a physician with any type of diabetes mellitus.
    (i)  A new onset of diabetes.
    (ii)  Poor glycemic control as evidenced by a glycosylated
 hemoglobin of nine and five=tenths or more in the ninety days
 before attending the training.
    (iii)  A change in treatment regimen from no diabetes
 medications to any diabetes medication, or from oral diabetes
 medication to insulin.
    (iv)  High risk for complications based on poor glycemic
 control; documented acute episodes of severe hypoglycemia or
 acute severe hyperglycemia occurring in the past year during
 which the individual needed third=party assistance for either
 emergency room visits or hospitalization.
    (v)  High risk based on documented complications of a lack
 of feeling in the foot or other foot complications such as
 foot ulcer or amputation, pre=proliferative or proliferative
 retinopathy or prior laser treatment of the eye, or kidney
 complications related to diabetes, such as macroalbuminuria or
 elevated creatinine.
    (b)  An individual who receives the initial training shall
 be eligible for a single follow=up training session of up to
 one hour each year.
    2.  a.  This section applies to the following classes of
 third=party payment provider contracts or policies delivered,
 issued for delivery, continued, or renewed in this state on or
 after July 1, 1999:
    (1)  Individual or group accident and sickness insurance
 providing coverage on an expense=incurred basis.
    (2)  An individual or group hospital or medical service
 contract issued pursuant to chapter 509, 514, or 514A.
    (3)  An individual or group health maintenance organization
 contract regulated under chapter 514B.
    (4)  Any other entity engaged in the business of insurance,
 risk transfer, or risk retention, which is subject to the
 jurisdiction of the commissioner.
    (5)  A plan established pursuant to chapter 509A for public
 employees.
    (6)  An organized delivery system licensed by the director
 of public health.
    b.  This section shall not apply to accident=only,
 specified disease, short=term hospital or medical, hospital
 confinement indemnity, credit, dental, vision, Medicare
 supplement, long=term care, basic hospital and
 medical=surgical expense coverage as defined by the
 commissioner, disability income insurance coverage, coverage
 issued as a supplement to liability insurance, workers'
 compensation or similar insurance, or automobile medical
 payment insurance.
    Sec. 2.  EFFECTIVE AND APPLICABILITY DATES.  This Act,
 being deemed of immediate importance, takes effect upon
 enactment and applies to the classes of third=party payment
 provider contracts or policies specified in Code section
 514C.18, as amended by this Act, that are delivered, issued
 for delivery, continued, or renewed in this state on or after
 July 1, 2009.


                                                             
                               PATRICK J. MURPHY
                               Speaker of the House


                                                             
                               JOHN P. KIBBIE
                               President of the Senate

    I hereby certify that this bill originated in the House and
 is known as House File 478, Eighty=third General Assembly.


                                                             
                               MARK BRANDSGARD
                               Chief Clerk of the House
 Approved                , 2009


                            
 CHESTER J. CULVER
 Governor

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