§ 27-18-38. Diabetes treatment.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued
for delivery, or renewed in this state that provides medical coverage that includes
coverage for physician services in a physician's office, and every policy that provides
major medical or similar comprehensive-type coverage, except for supplemental policies
that only provide coverage for specified diseases and other supplemental policies,
shall include coverage for the following equipment and supplies for the treatment
of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes,
if medically appropriate and prescribed by a physician: blood glucose monitors and
blood glucose monitors for the legally blind, test strips for glucose monitors and/or
visual reading, insulin, injection aids, cartridges for the legally blind, syringes,
insulin pumps and appurtenances to the pumps, insulin infusion devices, and oral agents
for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation.
(b) Upon the approval of new or improved diabetes equipment and supplies by the Food and
Drug Administration, all policies governed by this section shall guarantee coverage
of new diabetes equipment and supplies when medically appropriate and prescribed by
a physician. These policies shall also include coverage, when medically necessary,
for diabetes self-management education to ensure that persons with diabetes are instructed
in the self-management and treatment of their diabetes, including information on the
nutritional management of diabetes. The coverage for self-management education and
education relating to medical nutrition therapy shall be limited to medically necessary
visits upon the diagnosis of diabetes, where a physician diagnoses a significant change
in the patient's symptoms or conditions that necessitates changes in a patient's self-management,
or where reeducation or refresher training is necessary. This education, when medically
necessary and prescribed by a physician, may be provided only by the physician or,
upon the physician's referral to an appropriately licensed and certified healthcare
provider and may be conducted in group settings. Coverage for self-management education
and education relating to medical nutrition therapy shall also include home visits
when medically necessary.
(c) Benefit plans offered by an insurer may impose copayment and/or deductibles for the
benefits mandated by this chapter; however, in no instance shall the copayment or
deductible amount be greater than the copayment or deductible amount imposed for other
supplies, equipment, or physician office visits. Benefits for services under this
section shall be reimbursed in accordance with the respective principles and mechanisms
of reimbursement for each insurer, hospital, or medical service corporation, or health
maintenance organization.