STATE OF NEW YORK ________________________________________________________________________ 6923 2025-2026 Regular Sessions IN ASSEMBLY March 18, 2025 ___________ Introduced by M. of A. WEPRIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring health insurance plans to provide coverage for continuous blood glucose moni- tors for all children The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (A) of paragraph 15-a of subsection (i) of 2 section 3216 of the insurance law, as amended by chapter 338 of the laws 3 of 2003, is amended to read as follows: 4 (A) Every policy which provides medical coverage that includes cover- 5 age for physician services in a physician's office and every policy 6 which provides major medical or similar comprehensive-type coverage 7 shall include coverage for the following equipment and supplies for the 8 treatment of diabetes and other sugar disorders, if recommended or 9 prescribed by a physician or other licensed health care provider legally 10 authorized to prescribe under title eight of the education law, regard- 11 less of the patient's age: blood glucose monitors and blood glucose 12 monitors for the visually impaired, continuous blood glucose monitors, 13 including but not limited to devices produced by Dexcom, data management 14 systems, test strips for glucose monitors and visual reading and urine 15 testing strips, insulin, injection aids, cartridges for the visually 16 impaired, syringes, insulin pumps and appurtenances thereto, insulin 17 infusion devices, and oral agents for controlling blood sugar. In addi- 18 tion, the commissioner of the department of health shall provide and 19 periodically update by rule or regulation a list of additional diabetes 20 equipment and related supplies such as are medically necessary for the 21 treatment of diabetes, for which there shall also be coverage. Such 22 policies shall also include coverage for diabetes self-management educa- 23 tion to ensure that persons with diabetes are educated as to the proper 24 self-management and treatment of their diabetic condition, including EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10846-01-5
A. 6923 2 1 information on proper diets. Such coverage for self-management education 2 and education relating to diet shall be limited to visits medically 3 necessary upon the diagnosis of diabetes, where a physician diagnoses a 4 significant change in the patient's symptoms or conditions which neces- 5 sitate changes in a patient's self-management, or where reeducation or 6 refresher education is necessary. Such education may be provided by the 7 physician or other licensed health care provider legally authorized to 8 prescribe under title eight of the education law, or their staff, as 9 part of an office visit for diabetes diagnosis or treatment, or by a 10 certified diabetes nurse educator, certified nutritionist, certified 11 dietitian or registered dietitian upon the referral of a physician or 12 other licensed health care provider legally authorized to prescribe 13 under title eight of the education law. Education provided by the certi- 14 fied diabetes nurse educator, certified nutritionist, certified dieti- 15 tian or registered dietitian may be limited to group settings wherever 16 practicable. Coverage for self-management education and education 17 relating to diet shall also include home visits when medically neces- 18 sary. 19 § 2. Subparagraph (A) of paragraph 7 of subsection (k) of section 3221 20 of the insurance law, as amended by chapter 338 of the laws of 2003, is 21 amended to read as follows: 22 (A) Every group or blanket accident and health insurance policy issued 23 or issued for delivery in this state which provides medical coverage 24 that includes coverage for physician services in a physician's office 25 and every policy which provides major medical or similar comprehensive- 26 type coverage shall include coverage for the following equipment and 27 supplies for the treatment of diabetes and other sugar disorders, if 28 recommended or prescribed by a physician or other licensed health care 29 provider legally authorized to prescribe under title eight of the educa- 30 tion law, regardless of the patient's age: blood glucose monitors and 31 blood glucose monitors for the visually impaired, continuous blood 32 glucose monitors, including but not limited to devices produced by 33 Dexcom, data management systems, test strips for glucose monitors and 34 visual reading and urine testing strips, insulin, injection aids, 35 cartridges for the visually impaired, syringes, insulin pumps and 36 appurtenances thereto, insulin infusion devices, and oral agents for 37 controlling blood sugar. In addition, the commissioner of the department 38 of health shall provide and periodically update by rule or regulation a 39 list of additional diabetes equipment and related supplies such as are 40 medically necessary for the treatment of diabetes, for which there shall 41 also be coverage. Such policies shall also include coverage for diabetes 42 self-management education to ensure that persons with diabetes are 43 educated as to the proper self-management and treatment of their diabet- 44 ic condition, including information on proper diets. Such coverage for 45 self-management education and education relating to diet shall be limit- 46 ed to visits medically necessary upon the diagnosis of diabetes, where a 47 physician diagnoses a significant change in the patient's symptoms or 48 conditions which necessitate changes in a patient's self-management, or 49 where reeducation or refresher education is necessary. Such education 50 may be provided by the physician or other licensed health care provider 51 legally authorized to prescribe under title eight of the education law, 52 or their staff, as part of an office visit for diabetes diagnosis or 53 treatment, or by a certified diabetes nurse educator, certified nutri- 54 tionist, certified dietitian or registered dietitian upon the referral 55 of a physician or other licensed health care provider legally authorized 56 to prescribe under title eight of the education law. Education provided
A. 6923 3 1 by the certified diabetes nurse educator, certified nutritionist, certi- 2 fied dietitian or registered dietitian may be limited to group settings 3 wherever practicable. Coverage for self-management education and educa- 4 tion relating to diet shall also include home visits when medically 5 necessary. 6 § 3. Paragraph 1 of subsection (u) of section 4303 of the insurance 7 law, as amended by chapter 338 of the laws of 2003, is amended to read 8 as follows: 9 (1) A medical expense indemnity corporation or a health service corpo- 10 ration which provides medical coverage that includes coverage for physi- 11 cian services in a physician's office and every policy which provides 12 major medical or similar comprehensive-type coverage shall include 13 coverage for the following equipment and supplies for the treatment of 14 diabetes and other sugar disorders, if recommended or prescribed by a 15 physician or other licensed health care provider legally authorized to 16 prescribe under title eight of the education law, regardless of the 17 patient's age: blood glucose monitors and blood glucose monitors for 18 the visually impaired, continuous blood glucose monitors, including but 19 not limited to devices produced by Dexcom, data management systems, test 20 strips for glucose monitors and visual reading and urine testing strips, 21 insulin, injection aids, cartridges for the visually impaired, syringes, 22 insulin pumps and appurtenances thereto, insulin infusion devices, and 23 oral agents for controlling blood sugar. In addition, the commissioner 24 of the department of health shall provide and periodically update by 25 rule or regulation a list of additional diabetes equipment and related 26 supplies such as are medically necessary for the treatment of diabetes, 27 for which there shall also be coverage. Such policies shall also include 28 coverage for diabetes self-management education to ensure that persons 29 with diabetes are educated as to the proper self-management and treat- 30 ment of their diabetic condition, including information on proper diets. 31 Such coverage for self-management education and education relating to 32 diet shall be limited to visits medically necessary upon the diagnosis 33 of diabetes, where a physician diagnoses a significant change in the 34 patient's symptoms or conditions which necessitate changes in a 35 patient's self-management, or where reeducation or refresher education 36 is necessary. Such education may be provided by the physician or other 37 licensed health care provider legally authorized to prescribe under 38 title eight of the education law, or their staff, as part of an office 39 visit for diabetes diagnosis or treatment, or by a certified diabetes 40 nurse educator, certified nutritionist, certified dietitian or regis- 41 tered dietitian upon the referral of a physician or other licensed 42 health care provider legally authorized to prescribe under title eight 43 of the education law. Education provided by the certified diabetes nurse 44 educator, certified nutritionist, certified dietitian or registered 45 dietitian may be limited to group settings wherever practicable. Cover- 46 age for self-management education and education relating to diet shall 47 also include home visits when medically necessary. 48 § 4. This act shall take effect on the ninetieth day after it shall 49 have become a law, and shall apply to policies and contracts issued, 50 renewed, amended, modified or altered on or after such date.