REPORT TITLE: 
Diabetes Outpatient Coverage


DESCRIPTION:
Requires health insurance coverage under accident and sickness
individual policies and group health maintenance organization
and mutual benefit society contracts to include coverage for
diabetes outpatient self-management training and education and
equipment and supplies.  (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2657
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                     A BILL FOR AN ACT

RELATING TO HEALTH.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The legislature finds that approximately ninety
 
 2 thousand people living in Hawaii have diabetes.  Native Hawaiians
 
 3 and Asians experience a risk of developing diabetes that is twice
 
 4 that of the general U.S. population.  Native Hawaiians, compared
 
 5 to all other racial groups in the State during the years 1989
 
 6 through 1991, had the highest rate of mortality due to diabetes
 
 7 and its complications (34.7 out of every one hundred thousand
 
 8 residents), a rate that was one hundred thirty per cent higher
 
 9 than that of any other racial group in Hawaii (15.1 out of every
 
10 one hundred thousand residents).  Of native Hawaiians, those of
 
11 pure Hawaiian descent had the highest mortality rate (93.3 out of
 
12 every one hundred thousand residents), a rate that was five
 
13 hundred eighteen per cent higher than that of any other racial
 
14 group in the State.
 
15      The legislature finds that effective outpatient self-
 
16 management by persons with diabetes results directly in a
 
17 significant reduction in both the economic and human devastation
 
18 wrought by the disease.  There is ample evidence that tight
 
19 control of blood sugar levels through patient self-management can
 

 
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 1 dramatically lower the incidence of complications, increase life
 
 2 expectancy, and significantly enhance the quality of life of
 
 3 persons with diabetes.  In addition, studies show that providing
 
 4 individuals with diabetes with the appropriate supplies and
 
 5 training for self-management results in a decrease in health care
 
 6 services utilization and costs.  Hawaii fails to recover these
 
 7 cost savings, however, because most health plans only provide
 
 8 coverage for equipment and supplies, and do not cover diabetes
 
 9 self-management education and training.
 
10      The purpose of this Act is to require all individual
 
11 accident and sickness health care policies providing health care
 
12 coverage, and all group health care contracts issued by health
 
13 maintenance organizations and mutual benefit societies, to
 
14 provide coverage for outpatient diabetes self-management
 
15 training, education, equipment, and supplies.
 
16      SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended
 
17 by adding a new section to article 10A to be appropriately
 
18 designated to read as follows:
 
19      "§431:10A-    Coverage for diabetes.  (a)  Each policy of
 
20 accident and sickness insurance providing coverage for health
 
21 care, that is issued or renewed in this State, shall provide
 
22 coverage for outpatient diabetes self-management training,
 
23 education, equipment, and supplies, if:
 

 
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 1      (1)  The equipment, supplies, training, and education are
 
 2           medically necessary;
 
 3      (2)  The equipment, supplies, training, and education are
 
 4           prescribed by a health care professional authorized to
 
 5           prescribe under subsection (b); and
 
 6      (3)  The outpatient self-management training and education
 
 7           is provided by a provider with qualifications as set
 
 8           forth under subsection (c).
 
 9      (b)  Diabetes equipment, supplies, and outpatient self-
 
10 management training and education covered under this section
 
11 shall be prescribed by a licensed physician, advance practice
 
12 nurse with prescriptive authority.
 
13      (c)  Diabetes self-management training and education,
 
14 including medical nutrition training covered under this section
 
15 shall:
 
16      (1)  Be provided by a physician, podiatrist, nurse,
 
17           dietitian, pharmacist, or other licensed health care
 
18           provider who is certified by the current academic
 
19           eligibility requirements of the National Certification
 
20           Board for Diabetic Educators and has been certified in
 
21           diabetes self-management education and training;
 
22      (2)  Be based upon a diabetes program recognized by the
 
23           American Diabetes Association or a diabetes program
 

 
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 1           recognized by the American Diabetes Association (Hawaii
 
 2           chapter), the Hawaii State Department of Health, and
 
 3           the Hawaii Association of Diabetes Educators;
 
 4      (3)  Include medically necessary visits:
 
 5           (A)  For persons who are newly diagnosed or have
 
 6                received no prior diabetes education;
 
 7           (B)  Following a physician diagnosis that represents a
 
 8                significant change in the patient's symptoms or
 
 9                condition that warrants changes in self-
 
10                management; and
 
11           (C)  When reeducation or refresher training is
 
12                prescribed by a health care practitioner with
 
13                prescribing authority.
 
14      This subsection is satisfied by providing program services
 
15 in group sessions.  Individual training sessions may be provided
 
16 in lieu of a group program if medically necessary and recommended
 
17 by the treating physician because of language or physical
 
18 challenges, for example, severely impaired hearing or sight.
 
19      (d)  For purposes of this section:
 
20      "Diabetes equipment and supplies" means medically necessary
 
21 equipment and supplies, prescribed by a licensed physician or
 
22 advance practice nurse with prescriptive authority, including:
 
23      (1)  One blood glucose monitor per year, or as medically
 

 
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 1           necessary as recommended by a physician;
 
 2      (2)  Blood glucose monitors for the legally blind;
 
 3      (3)  Test strips for glucose monitors;
 
 4      (4)  Visual reading and urine testing strips;
 
 5      (5)  All insulin preparations and glucagon;
 
 6      (6)  All insulin cartridges;
 
 7      (7)  Insulin cartridges for the legally blind;
 
 8      (8)  Drawing up devices and monitors for the visually
 
 9           impaired;
 
10      (9)  Injection aids;
 
11     (10)  Syringes and lancets, including automatic lancing
 
12           devices;
 
13     (11)  Prescribed oral agents for controlling blood sugar that
 
14           are included on the open formulary, or as otherwise
 
15           medically necessary as prescribed by a physician;
 
16     (12)  Podiatric services and appliances, as defined by
 
17           medicare, for prevention of complications associated
 
18           with diabetes to the extent coverage is required under
 
19           medicare; and
 
20     (13)  Any other device, medication, equipment, or supply,
 
21           including insulin pumps, batteries, infusion sets, data
 
22           management systems, and control solutions used with
 
23           blood glucose monitors, for which coverage is required
 

 
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 1           under medicare from and after January 1, 1999 (and is
 
 2           effective six months after the coverage is required
 
 3           under medicare)."
 
 4      SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended
 
 5 by adding a new section to article 1 to be appropriately
 
 6 designated and to read as follows:
 
 7      "§432:1-    Diabetes coverage.  All individual and group
 
 8 health care contracts under this chapter shall provide, to the
 
 9 extent provided under section 431:10A-   , coverage for
 
10 outpatient diabetes self-management training, education,
 
11 equipment, and supplies."
 
12      SECTION 4.  Section 432D-23, Hawaii Revised Statutes, is
 
13 amended to read as follows:
 
14      "§432D-23  Required provisions and benefits.
 
15 Notwithstanding any provision of law to the contrary, each
 
16 policy, contract, plan, or agreement issued in the State after
 
17 January 1, 1995, by health maintenance organizations pursuant to
 
18 this chapter, shall include benefits provided in sections
 
19 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
20 431:10A-116.5, 431:10A-116.6, 431:10A-119, [and] 431:10-120,and
 
21 431:10A-   , and chapter 431M."
 
22      SECTION 5.  Statutory material to be repealed is bracketed.
 
23 New statutory material is underscored.
 

 
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 1      SECTION 6.  This Act shall take effect upon its approval.