§36-6060.2.

§36-6060.2.
   
   A. 1. For policies, contracts or agreements issued or renewed on and
   after November 1, 1996, any individual or group health insurance
   policy, contract or agreement providing coverage on an
   expense-incurred basis; any policy, contract or agreement issued for
   individual or group coverage by a not-for-profit hospital service and
   indemnity and medical service and indemnity corporation; contracts
   issued by health benefit plans including, but not limited to, health
   maintenance organizations, preferred provider organizations, health
   services corporations, physician sponsored networks, or physician
   hospital organizations; medical coverage provided by self-insureds
   that includes coverage for physician services in a physician's office,
   including coverage through private third-party payors; coverage
   provided through the State and Education Employees Group Insurance
   Board; and every policy, contract, or agreement which provides
   medical, major medical or similar comprehensive type coverage, group
   or blanket accident and health coverage, or medical expense, surgical,
   medical equipment, medical supplies, or drug prescription benefits
   shall, subject to the terms of the policy contract or agreement,
   include coverage for the following equipment, supplies and related
   services for the treatment of Type I, Type II, and gestational
   diabetes, when medically necessary and when recommended or prescribed
   by a physician or other licensed health care provider legally
   authorized to prescribe under the laws of this state:
   
   a. blood glucose monitors,
   
   b. blood glucose monitors to the legally blind,
   
   c. test strips for glucose monitors,
   
   d. visual reading and urine testing strips,
   
   e. insulin,
   
   f. injection aids,
   
   g. cartridges for the legally blind,
   
   h. syringes,
   
   i. insulin pumps and appurtenances thereto,
   
   j. insulin infusion devices,
   
   k. oral agents for controlling blood sugar, and
   
   l. podiatric appliances for prevention of complications associated
   with diabetes.
   
   2. The State Board of Health shall develop and annually update, by
   rule, a list of additional diabetes equipment, related supplies and
   health care provider services that are medically necessary for the
   treatment of diabetes, for which coverage shall also be included,
   subject to the terms of the policy, contract, or agreement, if such
   equipment and supplies have been approved by the federal Food and Drug
   Administration (FDA). Such additional FDA-approved diabetes equipment
   and related supplies, and health care provider services shall be
   determined in consultation with a national diabetes association
   affiliated with this state, and at least three (3) medical directors
   of health benefit plans, to be selected by the State Department of
   Health.
   
   3. All policies specified in this section shall also include coverage
   for:
   
   a. podiatric health care provider services as are deemed medically
   necessary to prevent complications from diabetes, and
   
   b. diabetes self-management training. As used in this subparagraph,
   "diabetes self-management training" means instruction in an inpatient
   or outpatient setting which enables diabetic patients to understand
   the diabetic management process and daily management of diabetic
   therapy as a method of avoiding frequent hospitalizations and
   complications. Diabetes self-management training shall comply with
   standards developed by the State Board of Health in consultation with
   a national diabetes association affiliated with this state and at
   least three (3) medical directors of health benefit plans selected by
   the State Department of Health. Such coverage for diabetes
   self-management training, including medical nutrition therapy relating
   to diet, caloric intake, and diabetes management, but excluding
   programs the only purpose of which are weight reduction, shall be
   limited to the following:
   
   (1) visits medically necessary upon the diagnosis of diabetes,
   
   (2) a physician diagnosis which represents a significant change in the
   patient's symptoms or condition making medically necessary changes in
   the patient's self-management, and
   
   (3) visits when reeducation or refresher training is medically
   necessary;
   
   provided, however, payment for the coverage required for diabetes
   self-management training pursuant to the provisions of this section
   shall be required only upon certification by the health care provider
   providing the training that the patient has successfully completed
   diabetes self-management training.
   
   4. Diabetes self-management training shall be supervised by a licensed
   physician or other licensed health care provider legally authorized to
   prescribe under the laws of this state. Diabetes self-management
   training may be provided by the physician or other appropriately
   registered, certified, or licensed health care professional as part of
   an office visit for diabetes diagnosis or treatment. Training provided
   by appropriately registered, certified, or licensed health care
   professionals may be provided in group settings where practicable.
   
   5. Coverage for diabetes self-management training and training related
   to medical nutrition therapy, when provided by a registered,
   certified, or licensed health care professional, shall also include
   home visits when medically necessary and shall include instruction in
   medical nutrition therapy only by a licensed registered dietician or
   licensed certified nutritionist when authorized by the patient's
   supervising physician when medically necessary.
   
   6. Such coverage may be subject to the same annual deductibles or
   coinsurance as may be deemed appropriate and as are consistent with
   those established for other covered benefits within a given policy.
   
   B. 1. Health benefit plans shall not reduce or eliminate coverage due
   to the requirements of this section.
   
   2. Enforcement of the provisions of this act shall be performed by the
   Insurance Department and the State Department of Health.
   
   3. The provisions of this section shall not apply to:
   
   a. health benefit plans designed only for issuance to subscribers
   eligible for coverage under Title XVIII of the Social Security Act or
   any similar coverage under a state or federal government plan,
   
   b. a health benefit plan which covers persons employed in more than
   one state where the benefit structure was the subject of collective
   bargaining affecting persons employed in more than one state, and
   
   c. agreements, contracts, or policies that provide coverage for a
   specified disease or other limited benefit coverage.