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28	28	STATE OF OKLAHOMA
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30	30	2nd Session of the 58th Legislature (2022)
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32	32	HOUSE BILL 3979 By: Bell
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38	38	AS INTRODUCED
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40	40	An Act relating to health insurance; amending 36 O.S.
41	41	2011, Section 6060.2, which relates to treatment of
42	42	diabetes; requiring private high deductible health
43	43	plans to allow insureds to set aside certain monies
44	44	for certain purpose; and providing an effective date .
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50	50	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
51	51	SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, is
52	52	amended to read as follows :
53	53	Section 6060.2 A. 1. Every health b enefit plan issued or
54	54	renewed on or after November 1, 1996, shall, subject to the terms of
55	55	the policy contract or agreement, include coverage for the following
56	56	equipment, supplies and related services for the treatment of Type
57	57	I, Type II, and gestational d iabetes, when medically necessary and
58	58	when recommended or prescribed by a physician or other licensed
59	59	health care provider legally authorized to prescribe under t he laws
60	60	of this state:
61	61	a. blood glucose monitors,
62	62	b. blood glucose monitors to the legally bli nd,
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89	89	c. test strips for glucose monitors,
90	90	d. visual reading and urine testing strips,
91	91	e. insulin,
92	92	f. injection aids,
93	93	g. cartridges for the legally blind,
94	94	h. syringes,
95	95	i. insulin pumps and appurtenances thereto,
96	96	j. insulin infusion devices,
97	97	k. oral agents for controlling blood sugar, and
98	98	l. podiatric appliances for prevention of complications
99	99	associated with diabetes.
100	100	2. The State Board of Health shall develop and a nnually update,
101	101	by rule, a list of additional diabetes equipment, related supplies
102	102	and health care provider services that are medically necessary for
103	103	the treatment of diabetes, for which coverage shall also be
104	104	included, subject to the terms of the policy, contract, or
105	105	agreement, if the equipment and supplies have been approved by the
106	106	federal Food and Drug Administration (FDA). Additional FDA -approved
107	107	diabetes equipment and related supplies, and health care provider
108	108	services shall be determined in consultat ion with a national
109	109	diabetes association affiliated with this state, and at least three
110	110	(3) medical directors of health benefit plans, to be selected by the
111	111	State Department of Health.
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138	138	3. All policies specified in this section shall also include
139	139	coverage for:
140	140	a. podiatric health care provider services as are deemed
141	141	medically necessary to prevent c omplications from
142	142	diabetes, and
143	143	b. diabetes self-management training. As used in this
144	144	subparagraph, "diabetes self-management training"
145	145	means instruction in an i npatient or outpatient
146	146	setting which enables diabetic patients to understand
147	147	the diabetic management process and daily management
148	148	of diabetic therapy as a method of avoiding frequent
149	149	hospitalizations and complications. Diabetes self -
150	150	management training sh all comply with standards
151	151	developed by the State Board of Health in consultation
152	152	with a national diabetes association affiliated with
153	153	this state and at least three medical directors of
154	154	health benefit plans selected by the State Department
155	155	of Health. Coverage for diabetes self-management
156	156	training, including medical nutrition therapy relating
157	157	to diet, caloric intake, and diabetes management, but
158	158	excluding programs the only purpose of which are
159	159	weight reduction, shall be limited to the following:
160	160	(1) visits medically necessary upon the diagnosis of
161	161	diabetes,
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188	188	(2) a physician diagnosis which represents a
189	189	significant change in the symptoms or condition
190	190	of the patient making medically necessary changes
191	191	in the self-management of the patient, and
192	192	(3) visits when reeducation or refresher training is
193	193	medically necessary;
194	194	provided, however, payment for the cove rage required for diabetes
195	195	self-management training pursuant to the provisions of this section
196	196	shall be required only upon certification by the health care
197	197	provider providing the training that the patient has successfully
198	198	completed diabetes self -management training.
199	199	4. Diabetes self-management training shall be supervised by a
200	200	licensed physician or other licensed health care provider legally
201	201	authorized to prescrib e under the laws of this state. Diabetes
202	202	self-management training may be provided by the phys ician or other
203	203	appropriately registered, certified, or licensed health care
204	204	professional as part of an office visit for diabetes diagnosis or
205	205	treatment. Training provided by appropriately registered,
206	206	certified, or licensed health care professionals may be provided in
207	207	group settings where practicable.
208	208	5. Coverage for diabetes self -management training and training
209	209	related to medical nutrition therapy, when provided by a registered,
210	210	certified, or licensed health care professional, shall also include
211	211	home visits when medically necessary and shall include instruction
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238	238	in medical nutrition therapy only by a licensed registered dietician
239	239	or licensed certified nutritionist when authorized by the
240	240	supervising physician of the patient when medically necessary.
241	241	6. Coverage may be subject to the same annual deductibles or
242	242	coinsurance as may be deemed appropriate and as are consistent with
243	243	those established for other covered ben efits within a given policy.
244	244	7. Any carrier that provides coverage for insulin pursuant to
245	245	this section shall cap the total amount that a covered person is
246	246	required to pay for insulin at an amount not to exceed Thirty
247	247	Dollars ($30.00) per thirty -day supply or Ninety Dollars ($90.00)
248	248	per ninety-day supply of insulin for each covered insulin
249	249	prescription, regardless of the amount or type of insulin needed to
250	250	fill the prescription or prescriptions of the covered person.
251	251	a. Nothing in this paragraph shall prev ent a carrier from
252	252	reducing the cost-sharing of a covered person to an
253	253	amount less than Thirty Dollars ($30.00) per thirty -
254	254	day supply or Ninety Dollars ($90.00) per ninety -day
255	255	supply.
256	256	b. The Insurance Commissioner shall ensure all carriers
257	257	comply with the requirements of this paragraph.
258	258	c. The Commissioner may promulgate rules as necessary to
259	259	implement and administer the requirements of this
260	260	paragraph and to align with federal requirements.
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287	287	8. Beginning on or after the effective date of this act, all
288	288	high deductible health plans, as defined in Section 6060.15 of this
289	289	title, issued, renewed or delivered in this state by a private
290	290	insurer providing coverage pursuant to this section shall allow an
291	291	insured to set aside funds on a tax -free basis, up to the
292	292	contribution limit p rovided in Section 223 of the Internal Revenue
293	293	Code, as amended, to pay for certain out-of-pocket medical expenses.
294	294	B. 1. Health benefit plans shall not reduce or eliminate
295	295	coverage due to the requirements of this section.
296	296	2. Enforcement of the provisio ns of this act section shall be
297	297	performed by the Insurance Department and the S tate Department of
298	298	Health.
299	299	C. As used in this section, "health benefit plan" means any
300	300	plan or arrangement as d efined in subsection C of Section 6060.4 of
301	301	this title.
302	302	SECTION 2. This act shall become effective November 1, 2022.
303	303
304	304	58-2-9706 KN 01/04/22

Oklahoma 2022 Regular Session

Oklahoma House Bill HB3979 Compare Versions