Oklahoma 2022 Regular Session

Oklahoma House Bill HB1019 Compare Versions

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1		-	An Act
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	29	+	SENATE FLOOR VERSION
	30	+	March 31, 2021
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	33	+	ENGROSSED HOUSE
3	34		BILL NO. 1019 By: Worthen, Bennett, Fugate,
4	35		Bell, Roe, Brewer and Grego
5	36		of the House
6	37
7	38		and
8	39
9		-	Simpson and Hicks of the
10		-	Senate
	40	+	Simpson of the Senate
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15	45		An Act relating to health insurance; amending 36 O.S.
16	46		2011, Section 6060.2, which relates to treatment of
17	47		diabetes; requiring health i nsurers to cap copayments
18	48		for insulin at a certain amount; authorizing insurers
19	49		to reduce copayments below cap; authorizing Insurance
20	50		Commissioner to enforce cap on copayments;
21	51		authorizing Insurance Commissioner to promulgate
22	52		rules; and providing an effect ive date.
23	53
24	54
25		-	~~SUBJECT: Health insurance~~
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26	56
27	57		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
28		-
29	58		SECTION 1. AMENDATORY 36 O.S. 2011, Section 6060.2, is
30	59		amended to read as follows:
31		-
32		-	Section 6060.2 A. 1. Eve ry health benefit plan issued or
	60	+	Section 6060.2. A. 1. Every health benefit plan issued or
33	61		renewed on or after November 1, 1996, shall, subject to the terms of
34	62		the policy contract or agreement, include coverage for the following
35	63		equipment, supplies and related services for the treatment of Typ e
36	64		I, Type II, and gestational diabetes, when medically necessary and
37	65		when recommended or prescribed by a physician or other licensed
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38	93		health care provider legally authorized to prescribe under the laws
39	94		of this state:
40		-
41	95		a. blood glucose monitors,
42		-
43	96		b. blood glucose monitors to the legally blind,
44		-
45	97		c. test strips for glucose monitors,
46		-	ENR. H. B. NO. 1019 Page 2
47	98		d. visual reading and urine testing strips,
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49	99		e. insulin,
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51	100		f. injection aids,
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53	101		g. cartridges for the legally blind,
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55	102		h. syringes,
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57	103		i. insulin pumps and appurtenances thereto,
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59	104		j. insulin infusion devices,
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61	105		k. oral agents for controlling blood sugar, and
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63	106		l. podiatric appliances for prevention of complications
64	107		associated with diabetes.
65		-
66	108		2. The State Board of Health shall develop and annually update,
67	109		by rule, a list of additional diabetes equipmen t, related supplies
68	110		and health care provider services that are medically necessary for
69	111		the treatment of diabetes, for which coverage shall also be
70	112		included, subject to the terms of the policy, contract, or
71	113		agreement, if the equipment and supplies have been approved by the
72	114		federal Food and Drug Administration (FDA). Additional FDA-approved
73	115		diabetes equipment and related supplies, and health care provider
74	116		services shall be determined in consultation with a national
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75	144		diabetes association affiliated with this s tate, and at least three
76	145		(3) medical directors of health benefit plans, to be selected by the
77	146		State Department of Health.
78		-
79	147		3. All policies specified in this section shall also include
80	148		coverage for:
81		-
82	149		a. podiatric health care provider services as are deemed
83	150		medically necessary to prevent complications from
84	151		diabetes, and
85		-
86	152		b. diabetes self-management training. As used in this
87	153		subparagraph, "diabetes self -management training"
88	154		means instruction in an inpatient or outpatient
89	155		setting which enables diabetic patients to understand
90	156		the diabetic management process and daily management
91		-	of diabetic therapy as a method of avoiding frequent ~~ENR. H. B. NO. 1019 Page 3~~
	157	+	of diabetic therapy as a method of avoiding frequent
92	158		hospitalizations and complications. Diabetes self -
93	159		management training shall comply with standards
94	160		developed by the State Board of Healt h in consultation
95	161		with a national diabetes association affiliated with
96	162		this state and at least three (3) medical directors of
97	163		health benefit plans selected by the State Department
98	164		of Health. Coverage for diabetes self -management
99	165		training, including medica l nutrition therapy relating
100	166		to diet, caloric intake, and diabetes manag ement, but
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101	194		excluding programs the only purpose of which are
102	195		weight reduction, shall be limited to the following:
103		-
104	196		(1) visits medically necessary upon the diagnosis of
105	197		diabetes,
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107	198		(2) a physician diagnosis which represents a
108	199		significant change in the symptoms or condition
109	200		of the patient making medically necessary changes
110	201		in the self-management of the patient, and
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112	202		(3) visits when reeducation or refresher training is
113	203		medically necessary;
114		-
115	204		provided, however, payment for the coverage required for diabetes
116	205		self-management training pursuant to the provisions of this section
117	206		shall be required only upon certification by the health care
118	207		provider providing the training that the patient has successfully
119	208		completed diabetes self-management training.
120		-
121	209		4. Diabetes self-management training shall be supervised by a
122	210		licensed physician or other licensed health care provider legally
123	211		authorized to prescribe under the laws of this state. Diabetes
124	212		self-management training may be provided by the physician or other
125	213		appropriately register ed, certified, or licensed health care
126	214		professional as part of an office visit for diabetes diagnosis or
127	215		treatment. Training provided by appropriately registered,
128	216		certified, or licens ed health care professionals may be provided in
129	217		group settings where pra cticable.
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131	245		5. Coverage for diabetes self -management training and training
132	246		related to medical nutrition therapy, when provided by a registered,
133	247		certified, or licensed health care profes sional, shall also include
134	248		home visits when medically necessary and shal l include instruction
135		-	in medical nutrition therapy only by a licensed registered dietician ~~ENR. H. B. NO. 1019 Page 4~~
	249	+	in medical nutrition therapy only by a licensed registered dietician
136	250		or licensed certified nutritionist when authorized by the
137	251		supervising physician of the patien t when medically necessary.
138		-
139	252		6. Coverage may be subject to the same annu al deductibles or
140	253		coinsurance as may be deemed appropriate and as are consistent with
141	254		those established for other covered benefits within a given policy.
142		-
143	255		7. Any carrier that provides coverage for insulin pursuant to
144	256		this section shall cap the total amount that a covered person is
145	257		required to pay for insulin at an amount not to exceed Thirty
146	258		Dollars ($30.00) per thirty-day supply or Ninety Dollars ($90.00)
147	259		per ninety-day supply of insulin for each covered insulin
148	260		prescription, regardless of the amount or ty pe of insulin needed to
149	261		fill the prescription or prescriptions of the covered person.
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151	262		a. Nothing in this paragraph shall prevent a carrier from
152	263		reducing the cost-sharing of a covered p erson to an
153	264		amount less than Thirty Dollars ($30.00) per thirty-
154	265		day supply or Ninety Dollars ($90.00) per ninety-day
155	266		supply.
156		-
157	267		b. The Insurance Commissioner shall ensure all carriers
158	268		comply with the requirements of this paragraph.
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160	296		c. The Commissioner may pro mulgate rules as necessary to
161	297		implement and administer the requirements of this
162	298		paragraph and to align with federal requirements.
163		-
164	299		B. 1. Health benefit plans shall not reduce or eliminate
165	300		coverage due to the requirements of this section.
166		-
167	301		2. Enforcement of the provisions of this act shall be performed
168	302		by the Insurance Departm ent and the State Department of Health.
169		-
170	303		C. As used in this section, "health benefit plan" means any
171	304		plan or arrangement as defined in subsection C of Section 6060.4 of
172	305		this title.
173		-
174	306		SECTION 2. This act shall become effective November 1, 202 1.
175		-	ENR. H. B. NO. 1019 Page 5
176		-	Passed the House of Representatives the 9th day of March, 2021.
177		-
178		-
179		-
180		-
181		-	Presiding Officer of the House
182		-	of Representatives
183		-
184		-
185		-	Passed the Senate the 13th day of April, 2021.
186		-
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189		-
190		-	Presiding Officer of the Senate
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192		-
193		-	OFFICE OF THE GOVERNOR
194		-	Received by the Office of the Governor this ____________________
195		-	day of ___________________, 20_______, at _______ o'clock _______ M.
196		-	By: _________________________________
197		-	Approved by the Governor of the State of Oklahoma this _________
198		-	day of ___________________, 20_______, at _______ o'clock _______ M.
199		-
200		-
201		-	_________________________________
202		-	Governor of the State of Oklahoma
203		-
204		-	OFFICE OF THE SECRETARY OF STATE
205		-	Received by the Office of the Secre tary of State this __________
206		-	day of ___________________, 20_______, at _______ o'clock _______ M.
207		-	By: _________________________________
208		-
	307	+	COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS
	308	+	March 31, 2021 - DO PASS