31A-22-626 - Coverage of diabetes.
31A-22-626. Coverage of diabetes.
(1) As used in this section, "diabetes" includes individuals with:
(a) complete insulin deficiency or type 1 diabetes;
(b) insulin resistant with partial insulin deficiency or type 2 diabetes; and
(c) elevated blood glucose levels induced by pregnancy or gestational diabetes.
(2) The commissioner shall establish, by rule, minimum standards of coverage fordiabetes for accident and health insurance policies that provide a health insurance benefit beforeJuly 1, 2000.
(3) In making rules under Subsection (2), the commissioner shall require rules:
(a) with durational limits, amount limits, deductibles, and coinsurance for the treatment ofdiabetes equitable or identical to coverage provided for the treatment of other illnesses ordiseases; and
(b) that provide coverage for:
(i) diabetes self-management training and patient management, including medicalnutrition therapy as defined by rule, provided by an accredited or certified program and referredby an attending physician within the plan and consistent with the health plan provisions forself-management education:
(A) recognized by the federal Health Care Financing Administration; or
(B) certified by the Department of Health; and
(ii) the following equipment, supplies, and appliances to treat diabetes when medicallynecessary:
(A) blood glucose monitors, including those for the legally blind;
(B) test strips for blood glucose monitors;
(C) visual reading urine and ketone strips;
(D) lancets and lancet devices;
(E) insulin;
(F) injection aides, including those adaptable to meet the needs of the legally blind, andinfusion delivery systems;
(G) syringes;
(H) prescriptive oral agents for controlling blood glucose levels; and
(I) glucagon kits.
(4) (a) Before October 1, 2003, the commissioner shall report to the Health and HumanServices Interim Committee on the effects of Section 31A-22-626. The report shall be based onthree years of data and shall include, to the extent possible:
(i) a review of the rules established under Subsection (3);
(ii) the change in availability of coverage resulting from this section;
(iii) the extent to which persons have been benefitted by the provisions of this section; and
(iv) the impact of this section on premiums.
(b) The Legislature shall consider the results of the report under Subsection (4)(a) whendetermining whether to reauthorize the provisions of this section.
Amended by Chapter 116, 2001 General Session