View Daily Data Tracking History
View Bill Text
View Statement of Purpose / Fiscal Impact
H0638.................................................by HEALTH AND WELFARE
HEALTH BENEFIT PLANS - DIABETES - Adds to existing law to provide for
coverage of diabetes treatment in managed care plans and small employer and
individual health benefit plans; and to define terms.
02/13 House intro - 1st rdg - to printing
02/14 Rpt prt - to Bus
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 638
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO DIABETES COVERAGE; AMENDING CHAPTER 39, TITLE 41, IDAHO CODE, BY
3 THE ADDITION OF A NEW SECTION 41-3941, IDAHO CODE, TO PROVIDE FOR COVERAGE
4 OF DIABETES TREATMENT BY MANAGED CARE PLANS, TO SPECIFY WHO MAY PROVIDE
5 DIABETES TREATMENT, TO PROVIDE THAT DIABETES COVERAGE BENEFITS SHALL BE
6 SUBJECT TO THE SAME ANNUAL DEDUCTIBLES OR COINSURANCE ESTABLISHED FOR
7 OTHER BENEFITS WITHIN A PLAN, TO PROVIDE THAT PRIVATE THIRD-PARTY PAYORS
8 SHALL NOT REDUCE OR ELIMINATE COVERAGE BASED ON DIABETES COVERAGE, TO PRO-
9 VIDE THAT THE DEPARTMENT OF INSURANCE SHALL PROMULGATE RULES AND TO DEFINE
10 TERMS; AMENDING CHAPTER 47, TITLE 41, IDAHO CODE, BY THE ADDITION OF A NEW
11 SECTION 41-4708A, IDAHO CODE, TO PROVIDE FOR COVERAGE OF DIABETES TREAT-
12 MENT BY SMALL EMPLOYER HEALTH BENEFIT PLANS, TO SPECIFY WHO MAY PROVIDE
13 DIABETES TREATMENT, TO PROVIDE THAT DIABETES COVERAGE BENEFITS SHALL BE
14 SUBJECT TO THE SAME ANNUAL DEDUCTIBLES OR COINSURANCE ESTABLISHED FOR
15 OTHER BENEFITS WITHIN A PLAN, TO PROVIDE THAT PRIVATE THIRD-PARTY PAYORS
16 SHALL NOT REDUCE OR ELIMINATE COVERAGE BASED ON DIABETES COVERAGE, TO PRO-
17 VIDE THAT THE DEPARTMENT OF INSURANCE SHALL PROMULGATE RULES AND TO DEFINE
18 TERMS; AND AMENDING CHAPTER 52, TITLE 41, IDAHO CODE, BY THE ADDITION OF A
19 NEW SECTION 41-5208A, IDAHO CODE, TO PROVIDE FOR COVERAGE OF DIABETES
20 TREATMENT BY INDIVIDUAL HEALTH BENEFIT PLANS, TO SPECIFY WHO MAY PROVIDE
21 DIABETES TREATMENT, TO PROVIDE THAT DIABETES COVERAGE BENEFITS SHALL BE
22 SUBJECT TO THE SAME ANNUAL DEDUCTIBLES OR COINSURANCE ESTABLISHED FOR
23 OTHER BENEFITS WITHIN A PLAN, TO PROVIDE THAT PRIVATE THIRD-PARTY PAYORS
24 SHALL NOT REDUCE OR ELIMINATE COVERAGE BASED ON DIABETES COVERAGE, TO PRO-
25 VIDE THAT THE DEPARTMENT OF INSURANCE SHALL PROMULGATE RULES AND TO DEFINE
26 TERMS.
27 Be It Enacted by the Legislature of the State of Idaho:
28 SECTION 1. That Chapter 39, Title 41, Idaho Code, be, and the same is
29 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
30 ignated as Section 41-3941, Idaho Code, and to read as follows:
31 41-3941. DIABETES COVERAGE. (1) On and after July 1, 2002, managed care
32 plans subject to the provisions of this chapter shall provide coverage for
33 diabetes equipment and supplies, as defined in subsection (5) of this section,
34 and outpatient self-management training and education, including medical
35 nutrition therapy, for the treatment of diabetes, as defined in subsection (5)
36 of this section, if prescribed by a licensed health care professional autho-
37 rized by law to prescribe such items.
38 (2) Diabetes outpatient self-management training and education as pro-
39 vided in this section shall be provided by a licensed health care professional
40 with expertise in diabetes or by a diabetes educator certified by the national
41 certification board for diabetes educators.
42 (3) (a) The benefits provided in this section shall be subject to the
43 same annual deductibles or coinsurance established for all other covered
2
1 benefits within a given managed care plan.
2 (b) Private third-party payors shall not reduce or eliminate coverage due
3 to the requirements of this section.
4 (4) The department of insurance shall promulgate rules consistent with
5 the provisions of this section.
6 (5) As used in this section:
7 (a) "Diabetes" means:
8 (i) Type 1 insulin deficient diabetes;
9 (ii) Type 2 diabetes, marked by insulin resistance and partial insu-
10 lin deficiency;
11 (iii) Gestational diabetes, marked by elevated blood glucose levels
12 during pregnancy; and
13 (iv) Any other medical condition that wholly or partially consists
14 of elevated blood glucose levels.
15 (b) "Diabetes equipment and supplies" includes only:
16 (i) Blood glucose measuring devices and supplies, including such
17 devices and supplies for visually-impaired individuals;
18 (ii) Visual reading urine and ketone strips;
19 (iii) Lancets and lancet devices;
20 (iv) Insulin;
21 (v) Injection aids, including those adaptable to meet the needs of
22 the legally blind, and infusion pumps and supplies required for the
23 use of an insulin pump;
24 (vi) Syringes;
25 (vii) Prescriptive oral agents, for controlling blood glucose lev-
26 els, for each class of agents approved by the United States food and
27 drug administration for the treatment and management of diabetes; and
28 (viii) Glucagon kits.
29 SECTION 2. That Chapter 47, Title 41, Idaho Code, be, and the same is
30 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
31 ignated as Section 41-4708A, Idaho Code, and to read as follows:
32 41-4708A. DIABETES COVERAGE. (1) On and after July 1, 2002, health bene-
33 fit plans subject to the provisions of this chapter shall provide coverage for
34 diabetes equipment and supplies, as defined in subsection (5) of this section,
35 and outpatient self-management training and education, including medical
36 nutrition therapy, for the treatment of diabetes, as defined in subsection (5)
37 of this section, if prescribed by a licensed health care professional autho-
38 rized by law to prescribe such items.
39 (2) Diabetes outpatient self-management training and education as pro-
40 vided in this section shall be provided by a licensed health care professional
41 with expertise in diabetes or by a diabetes educator certified by the national
42 certification board for diabetes educators.
43 (3) (a) The benefits provided in this section shall be subject to the
44 same annual deductibles or coinsurance established for all other covered
45 benefits within a given health benefit plan.
46 (b) Private third-party payors shall not reduce or eliminate coverage due
47 to the requirements of this section.
48 (4) The department of insurance shall promulgate rules consistent with
49 the provisions of this section.
50 (5) As used in this section:
51 (a) "Diabetes" means:
52 (i) Type 1 insulin deficient diabetes;
53 (ii) Type 2 diabetes, marked by insulin resistance and partial insu-
3
1 lin deficiency;
2 (iii) Gestational diabetes, marked by elevated blood glucose levels
3 during pregnancy; and
4 (iv) Any other medical condition that wholly or partially consists
5 of elevated blood glucose levels.
6 (b) "Diabetes equipment and supplies" includes only:
7 (i) Blood glucose measuring devices and supplies, including such
8 devices and supplies for visually-impaired individuals;
9 (ii) Visual reading urine and ketone strips;
10 (iii) Lancets and lancet devices;
11 (iv) Insulin;
12 (v) Injection aids, including those adaptable to meet the needs of
13 the legally blind, and infusion pumps and supplies required for the
14 use of an insulin pump;
15 (vi) Syringes;
16 (vii) Prescriptive oral agents, for controlling blood glucose lev-
17 els, for each class of agents approved by the United States food and
18 drug administration for the treatment and management of diabetes; and
19 (viii) Glucagon kits.
20 SECTION 3. That Chapter 52, Title 41, Idaho Code, be, and the same is
21 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
22 ignated as Section 41-5208A, Idaho Code, and to read as follows:
23 41-5208A. DIABETES COVERAGE. (1) On and after July 1, 2002, health bene-
24 fit plans subject to the provisions of this chapter shall provide coverage for
25 diabetes equipment and supplies, as defined in subsection (5) of this section,
26 and outpatient self-management training and education, including medical
27 nutrition therapy, for the treatment of diabetes, as defined in subsection (5)
28 of this section, if prescribed by a licensed health care professional autho-
29 rized by law to prescribe such items.
30 (2) Diabetes outpatient self-management training and education as pro-
31 vided in this section shall be provided by a licensed health care professional
32 with expertise in diabetes or by a diabetes educator certified by the national
33 certification board for diabetes educators.
34 (3) (a) The benefits provided in this section shall be subject to the
35 same annual deductibles or coinsurance established for all other covered
36 benefits within a given health benefit plan.
37 (b) Private third-party payors shall not reduce or eliminate coverage due
38 to the requirements of this section.
39 (4) The department of insurance shall promulgate rules consistent with
40 the provisions of this section.
41 (5) As used in this section:
42 (a) "Diabetes" means:
43 (i) Type 1 insulin deficient diabetes;
44 (ii) Type 2 diabetes, marked by insulin resistance and partial insu-
45 lin deficiency;
46 (iii) Gestational diabetes, marked by elevated blood glucose levels
47 during pregnancy; and
48 (iv) Any other medical condition that wholly or partially consists
49 of elevated blood glucose levels.
50 (b) "Diabetes equipment and supplies" includes only:
51 (i) Blood glucose measuring devices and supplies, including such
52 devices and supplies for visually-impaired individuals;
53 (ii) Visual reading urine and ketone strips;
4
1 (iii) Lancets and lancet devices;
2 (iv) Insulin;
3 (v) Injection aids, including those adaptable to meet the needs of
4 the legally blind, and infusion pumps and supplies required for the
5 use of an insulin pump;
6 (vi) Syringes;
7 (vii) Prescriptive oral agents, for controlling blood glucose lev-
8 els, for each class of agents approved by the United States food and
9 drug administration for the treatment and management of diabetes; and
10 (viii) Glucagon kits.
STATEMENT OF PURPOSE
RS 11930C1
The purpose of this legislation is to provide for the addition of a
new section in the Idaho Code that includes the insurance coverage
for all equipment, supplies and self management education for
diabetics.
FISCAL IMPACT
There is no fiscal impact to the State of Idaho.
Contact:
Name: Representative Montgomery
Phone: 332-1076
STATEMENT OF PURPOSE/FISCAL NOTE H 638