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STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
HOUSE BILL 2550 By: Virgin
AS INTRODUCED
An Act relating to health insurance; amending 36 O.S.
2011, Section 6060.2, which relates to treatment of
diabetes; requiring health bene fit plans to cap
insulin copays at a certain amount; allowing insurers
to reduce copays below the cap; requiring the
Insurance Commissioner to enforce certain
requirements; allowing the Insurance Commissioner to
promulgate rules; and providing an effective date.
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. Every 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,
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b. blood glucose monitors to the legally blind,
c. test strips for glucose monito rs,
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 medic ally 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 approved by the
federal Food and Drug Administration (FDA). Additi onal 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 pla ns, to be selected by the
State Department of Health.
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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 wi th
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 nutrition therapy relating
to diet, caloric intake, and diabetes m anagement, 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,
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(2) a physician diagnosis which represents a
significant change in the sympt oms 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 professional, shall also include
home visits when medically necessary and shall include instruction
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in medical nutrition therapy only by a licensed registered dietician
or licensed certified nutritionist when authorized by the
supervising physician of the patient 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 health benefit plan that provides coverage for ins ulin
shall cap the total amount that the insured is required to pay for
insulin at an amount not to exceed One Hundred Dollars ($100.00) per
thirty-day supply of insulin, regardless of the amount, type or
number of prescriptions of insulin required by the insured for that
period.
a. Nothing in this subsection shall prevent an insurer
from reducing the cost sharing of the insured to an
amount less than One Hundred Dollars ($100.00).
b. The Insurance Commis sioner shall ensure all insurers
comply with the requirements of this section.
c. The Commissioner may promulgate rules as necessary to
implement and administer the requirements of this
section 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.
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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.
58-1-6694 AB 01/12/21