An Act
ENROLLED HOUSE
BILL NO. 1019 By: Worthen, Bennett, Fugate,
Bell, Roe, Brewer and Grego
of the House
and
Simpson and Hicks of the
Senate
An Act relating to health insurance; amending 36 O.S.
2011, Section 6060.2, which relates to treatment of
diabetes; requiring health insurers to cap copayments
for insulin at a certain amount; authorizing insurers
to reduce copayments below cap; authorizing Insurance
Commissioner to enforce cap on copayments;
authorizing Insurance Commissioner to promulgate
rules; and providing an effective date.
SUBJECT: Health insurance
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2011, Section 6060.2, is
amended to read as follows:
Section 6060.2 A. 1. Eve ry health benefit plan issued or
renewed on or after November 1, 1996, 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 th e legally blind,
c. test strips for glucose monitors,
ENR. H. B. NO. 1019 Page 2
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 devic es,
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, rela ted 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 the equipment and supplies have been approv ed by the
federal Food and Drug Administration (FDA). 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, a nd 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 u nderstand
the diabetic management process and daily management
of diabetic therapy as a method of avoiding frequent ENR. H. B. NO. 1019 Page 3
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. Coverage for diabetes self -management
training, including medical nu trition 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 symptoms or condition
of the patient making medically necessary changes
in the self-management of the patient, 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 prof essional, shall also include
home visits when medically necessary and shall include instruction
in medical nutrition therapy only by a licensed registered dietician ENR. H. B. NO. 1019 Page 4
or licensed certified nutritionist when authorized by the
supervising physician of the pati ent when medically necessary.
6. 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.
7. Any carrier that provi des coverage for insulin pursuant to
this section shall cap the total amount that a covered person is
required to pay for insulin at an amount not to exceed Thirty
Dollars ($30.00) per thirty-day supply or Ninety Dollars ($90.00)
per ninety-day supply of insulin for each covered insulin
prescription, regardless of the amount or type of insulin needed to
fill the prescription or prescriptions of the covered person.
a. Nothing in this paragraph shall prevent a carrier from
reducing the cost-sharing of a covered person to an
amount less than Thirty Dollars ($30.00) per thirty-
day supply or Ninety Dollars ($90.00) per ninety-day
supply.
b. The Insurance Commissioner shall ensure all carriers
comply with the requirements of this paragraph.
c. The Commissioner may promulgate rules as necessary to
implement and administer the requirements of this
paragraph and to align with federal requirements.
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.
C. As used in this section, "health benefit plan" means any
plan or arrangement as defined in subsection C of Section 6060.4 of
this title.
SECTION 2. This act shall become effective November 1, 2021.
ENR. H. B. NO. 1019 Page 5
Passed the House of Representatives the 9th day of March, 2021.
Presiding Officer of the House
of Representatives
Passed the Senate the 13th day of April, 2021.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secre tary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________