House File 478 - Enrolled
HOUSE FILE 478
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
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
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.
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
(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
(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
(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
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.
Chief Clerk of the House
Approved , 2009
CHESTER J. CULVER