§ 27-41-44. 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
b
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§ 27-41-44. 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 visual reading, insulin, injection aids,
cartridges for the legally blind, syringes, insulin pumps and appurtenances to them,
insulin infusion devices, 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 this 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.
This 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 health maintenance organization 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.