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STATE OF OKLAHOMA
2nd Session of the 58th Legislature (2022)
HOUSE BILL 3979 By: Bell
AS INTRODUCED
An Act relating to health insurance; amending 36 O.S.
2011, Section 6060.2, which relates to treatment of
diabetes; requiring private high deductible health
plans to allow insureds to set aside certain monies
for certain purpose; and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, is
amended to read as follows :
Section 6060.2 A. 1. Every health b enefit 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 d iabetes, when medically necessary and
when recommended or prescribed by a physician or other licensed
health care provider legally authorized to prescribe under t he laws
of this state:
a. blood glucose monitors,
b. blood glucose monitors to the legally bli nd,
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c. test strips for glucose monitors,
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 a nnually update,
by rule, a list of additional diabetes equipment, related 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 approved 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 consultat ion with a national
diabetes association affiliated with this state, and at least three
(3) medical directors of health benefit plans, 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 c omplications from
diabetes, and
b. diabetes self-management training. As used in this
subparagraph, "diabetes self-management training"
means instruction in an i npatient 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 sh all 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 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 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,
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(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 cove rage 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 prescrib e under the laws of this state. Diabetes
self-management training may be provided by the phys ician 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 ben efits within a given policy.
7. Any carrier that provides 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 prev ent 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.
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8. Beginning on or after the effective date of this act, all
high deductible health plans, as defined in Section 6060.15 of this
title, issued, renewed or delivered in this state by a private
insurer providing coverage pursuant to this section shall allow an
insured to set aside funds on a tax -free basis, up to the
contribution limit p rovided in Section 223 of the Internal Revenue
Code, as amended, to pay for certain out-of-pocket medical expenses.
B. 1. Health benefit plans shall not reduce or eliminate
coverage due to the requirements of this section.
2. Enforcement of the provisio ns of this act section shall be
performed by the Insurance Department and the S tate Department of
Health.
C. As used in this section, "health benefit plan" means any
plan or arrangement as d efined in subsection C of Section 6060.4 of
this title.
SECTION 2. This act shall become effective November 1, 2022.
58-2-9706 KN 01/04/22