§ 27-20-30. 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, shall include coverage for the
following equipment and supplies for the treatment of insulin treated diabetes, non-insulin
treated diabetes, and gestational diabetes when medically appropriate and prescribed
by a physician: blood glucose monitors and blood glucose monitors for the legally
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§ 27-20-30. 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, shall include coverage for the
following equipment and supplies for the treatment of insulin treated diabetes, non-insulin
treated diabetes, and gestational diabetes when 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. Upon the approval of
new or improved diabetes equipment and supplies by the Food and Drug Administration,
all policies governed by this chapter 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 his or her 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.
(b) Benefit plans offered by a medical service corporation may impose copayment or deductibles
or both 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 chapter 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.