House Study Bill 153
HOUSE FILE
BY (PROPOSED COMMITTEE ON
COMMERCE BILL BY
CHAIRPERSON PETERSEN)
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to health insurance coverage for diabetes
2 self=management training and education programs and providing
3 effective and applicability dates.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
5 TLSB 1989HC 83
6 av/nh/8
PAG LIN
1 1 Section 1. Section 514C.18, Code 2009, is amended to read
1 2 as follows:
1 3 514C.18 DIABETES COVERAGE.
1 4 1. Notwithstanding the uniformity of treatment
1 5 requirements of section 514C.6, a policy or contract providing
1 6 for third=party payment or prepayment of health or medical
1 7 expenses shall provide coverage benefits for the cost
1 8 associated with equipment, supplies, and self=management
1 9 training and education for the treatment of all types of
1 10 diabetes mellitus when prescribed by a physician licensed
1 11 under chapter 148. Coverage benefits shall include coverage
1 12 for the cost associated with all of the following:
1 13 a. Blood glucose meter and glucose strips for home
1 14 monitoring.
1 15 b. Payment for diabetes self=management training and
1 16 education only under all of the following conditions:
1 17 (1) The physician managing the individual's diabetic
1 18 condition certifies that such services are needed under a
1 19 comprehensive plan of care related to the individual's
1 20 diabetic condition to ensure therapy compliance or to provide
1 21 the individual with necessary skills and knowledge to
1 22 participate in the management of the individual's condition.
1 23 (2) The diabetic diabetes self=management training and
1 24 education program is certified by the Iowa department of
1 25 public health. The department shall consult with the American
1 26 diabetes association, Iowa affiliate, in developing the
1 27 standards for certification of diabetes education programs as
1 28 follows:
1 29 (a) Initial training shall cover up to that cover at least
1 30 ten hours of initial outpatient diabetes self=management
1 31 training within a continuous twelve=month period each year for
1 32 each individual that meets any of the following conditions:
1 33 diagnosed by a physician with any type of diabetes mellitus.
1 34 (i) A new onset of diabetes.
1 35 (ii) Poor glycemic control as evidenced by a glycosylated
2 1 hemoglobin of nine and five=tenths or more in the ninety days
2 2 before attending the training.
2 3 (iii) A change in treatment regimen from no diabetes
2 4 medications to any diabetes medication, or from oral diabetes
2 5 medication to insulin.
2 6 (iv) High risk for complications based on poor glycemic
2 7 control; documented acute episodes of severe hypoglycemia or
2 8 acute severe hyperglycemia occurring in the past year during
2 9 which the individual needed third=party assistance for either
2 10 emergency room visits or hospitalization.
2 11 (v) High risk based on documented complications of a lack
2 12 of feeling in the foot or other foot complications such as
2 13 foot ulcer or amputation, pre=proliferative or proliferative
2 14 retinopathy or prior laser treatment of the eye, or kidney
2 15 complications related to diabetes, such as macroalbuminuria or
2 16 elevated creatinine.
2 17 (b) An individual who receives the initial training shall
2 18 be eligible for a single follow=up training session of up to
2 19 one hour each year.
2 20 2. a. This section applies to the following classes of
2 21 third=party payment provider contracts or policies delivered,
2 22 issued for delivery, continued, or renewed in this state on or
2 23 after July 1, 1999:
2 24 (1) Individual or group accident and sickness insurance
2 25 providing coverage on an expense=incurred basis.
2 26 (2) An individual or group hospital or medical service
2 27 contract issued pursuant to chapter 509, 514, or 514A.
2 28 (3) An individual or group health maintenance organization
2 29 contract regulated under chapter 514B.
2 30 (4) Any other entity engaged in the business of insurance,
2 31 risk transfer, or risk retention, which is subject to the
2 32 jurisdiction of the commissioner.
2 33 (5) A plan established pursuant to chapter 509A for public
2 34 employees.
2 35 (6) An organized delivery system licensed by the director
3 1 of public health.
3 2 b. This section shall not apply to accident=only,
3 3 specified disease, short=term hospital or medical, hospital
3 4 confinement indemnity, credit, dental, vision, Medicare
3 5 supplement, long=term care, basic hospital and
3 6 medical=surgical expense coverage as defined by the
3 7 commissioner, disability income insurance coverage, coverage
3 8 issued as a supplement to liability insurance, workers'
3 9 compensation or similar insurance, or automobile medical
3 10 payment insurance.
3 11 Sec. 2. EFFECTIVE AND APPLICABILITY DATES. This Act,
3 12 being deemed of immediate importance, takes effect upon
3 13 enactment and applies to the classes of third=party payment
3 14 provider contracts or policies specified in Code section
3 15 514C.18, as amended by this Act, that are delivered, issued
3 16 for delivery, continued, or renewed in this state on or after
3 17 July 1, 2009.
3 18 EXPLANATION
3 19 This bill amends Code section 514C.18 to provide that
3 20 required health coverage benefits for outpatient diabetes
3 21 self=management training include at least 10 hours of such
3 22 training each year for each individual diagnosed by a
3 23 physician with any type of diabetes mellitus. Currently such
3 24 coverage is required only for 10 hours of initial training for
3 25 each individual who meets one of the enumerated conditions.
3 26 The coverage requirements apply to classes of third=party
3 27 payment provider contracts or policies that are individual or
3 28 group accident and sickness insurance providing coverage on an
3 29 expense=incurred basis; individual or group hospital or
3 30 medical service contracts issued pursuant to Code chapter 509,
3 31 514, or 514A; individual or group health maintenance
3 32 organization contracts regulated under Code chapter 514B; any
3 33 other entity engaged in the business of insurance, risk
3 34 transfer, or risk retention, which is subject to the
3 35 jurisdiction of the commissioner of insurance; plans
4 1 established pursuant to Code chapter 509A for public
4 2 employees; and organized delivery systems licensed by the
4 3 director of public health.
4 4 The bill takes effect upon enactment and applies to the
4 5 classes of third=party payment provider contracts or policies
4 6 specified in Code section 514C.18 that are delivered, issued
4 7 for delivery, continued, or renewed in this state on or after
4 8 July 1, 2009.
4 9 LSB 1989HC 83
4 10 av/nh/8