§ 27-18-38 - Diabetes treatment.
SECTION 27-18-38
§ 27-18-38 Diabetes treatment. – (a) Every individual or group health insurance contract, plan, or policydelivered, issued for delivery or renewed in this state which provides medicalcoverage that includes coverage for physician services in a physician's office,and every policy which provides major medical or similar comprehensive-typecoverage, except for supplemental policies which only provide coverage forspecified diseases and other supplemental policies, shall include coverage forthe following equipment and supplies for the treatment of insulin treateddiabetes, non-insulin treated diabetes, and gestational diabetes, if medicallyappropriate and prescribed by a physician: blood glucose monitors and bloodglucose monitors for the legally blind, test strips for glucose monitors and/orvisual reading, insulin, injection aids, cartridges for the legally blind,syringes, insulin pumps and appurtenances to the pumps, insulin infusiondevices, and oral agents for controlling blood sugar and therapeutic/moldedshoes for the prevention of amputation.
(b) Upon the approval of new or improved diabetes equipmentand supplies by the Food and Drug Administration, all policies governed by thissection shall guarantee coverage of new diabetes equipment and supplies whenmedically appropriate and prescribed by a physician. These policies shall alsoinclude coverage, when medically necessary, for diabetes self-managementeducation to ensure that persons with diabetes are instructed in theself-management and treatment of their diabetes, including information on thenutritional management of diabetes. The coverage for self-management educationand education relating to medical nutrition therapy shall be limited tomedically necessary visits upon the diagnosis of diabetes, where a physiciandiagnoses a significant change in the patient's symptoms or conditions whichnecessitate changes in a patient's self-management, or where reeducation orrefresher training is necessary. This education when medically necessary andprescribed by a physician, may be provided only by the physician or, upon hisor her referral to an appropriately licensed and certified health care providerand may be conducted in group settings. Coverage for self-management educationand education relating to medical nutrition therapy shall also include homevisits when medically necessary.
(c) Benefit plans offered by an insurer may impose co-paymentand/or deductibles for the benefits mandated by this chapter; however, in noinstance shall the co-payment or deductible amount be greater than theco-payment or deductible amount imposed for other supplies, equipment orphysician office visits. Benefits for services under this section shall bereimbursed in accordance with the respective principles and mechanisms ofreimbursement for each insurer, hospital, or medical service corporation, orhealth maintenance organization.