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53	53	STATE OF OKLAHOMA
54	54
55	55	1st Session of the 59th Legislature (2023)
56	56
57	57	SENATE BILL 142 By: Hicks
58	58
59	59
60	60
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63	63	AS INTRODUCED
64	64
65	65	An Act relating to health insurance; amending 36 O.S.
66	66	2021, Section 6060.2, as amended by Section 1,
67	67	Chapter 199, O.S.L. 2022 (36 O.S. Sup p. 2022, Section
68	68	6060.2), which relates to treatment of diabetes;
69	69	modifying copayment cap of certain insulin supply;
70	70	requiring cap on copayment for certain diabetes
71	71	equipment and supplies; requiring reduction in cost-
72	72	sharing amount for certain insulin supply or diabetes
73	73	equipment or supply that is less than copayment cap;
74	74	conforming language; and providing an effective dat e.
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79	79	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
80	80	SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, as
81	81	amended by Section 1, Chapter 199 , O.S.L. 2022 (36 O.S. Supp. 2022,
82	82	Section 6060.2), is amended to read as follows:
83	83	Section 6060.2. A. 1. Every health benefit plan issued or
84	84	renewed on or after November 1, 1996, shall, subject to the te rms of
85	85	the policy contract or agreement, i nclude coverage for the following
86	86	equipment, supplies and related services for the treatment of Type
87	87	I, Type II, and gestational diabetes, when medically necessary and
88	88	when recommended or prescribed by a physician or other licensed
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140	140	health care provider leg ally authorized to prescribe under the laws
141	141	of this state:
142	142	a. blood glucose monitors,
143	143	b. blood glucose monitors to the legally bl ind,
144	144	c. test strips for glucose monito rs,
145	145	d. visual reading and urine testing strips,
146	146	e. insulin,
147	147	f. injection aids,
148	148	g. cartridges for the legally blind,
149	149	h. syringes,
150	150	i. insulin pumps and appurtenances thereto,
151	151	j. insulin infusion devices,
152	152	k. oral agents for controlling blood sugar, and
153	153	l. podiatric appliances for prevention of complicatio ns
154	154	associated with diabetes.
155	155	2. The State Board of Health shall develop and annually update,
156	156	by rule, a list of additional diabetes equipment, related supplies
157	157	and health care provider services that are medic ally necessary for
158	158	the treatment of diabetes, f or which coverage shall also be
159	159	included, subject to the terms of the policy, contract, or
160	160	agreement, if the equipment and supplies have been approved by the
161	161	federal Food and Drug Administration (FDA). Additi onal FDA-approved
162	162	diabetes equipment and relate d supplies, and health care provider
163	163	services, shall be determined in consultation with a national
164	164
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215	215	diabetes association affiliated with this state, and at least three
216	216	(3) medical directors of health benefit pl ans, to be selected by the
217	217	State Department of H ealth.
218	218	3. All policies specified in this section shall also include
219	219	coverage for:
220	220	a. podiatric health care provider services as are deemed
221	221	medically necessary to prevent complications from
222	222	diabetes, and
223	223	b. diabetes self-management training. As used in th is
224	224	subparagraph, “diabetes self-management training”
225	225	means instruction in an inpatient or outpatient
226	226	setting which enables diabetic patients to understand
227	227	the diabetic management process and daily management
228	228	of diabetic therapy as a method of avoiding freq uent
229	229	hospitalizations and complications. Diabetes self-
230	230	management training shall comply with standards
231	231	developed by the State Board of Health in consultation
232	232	with a national diabetes association affiliated w ith
233	233	this state and at least three medical direct ors of
234	234	health benefit plans selected by th e State Department
235	235	of Health. Coverage for diabetes self-management
236	236	training, including medical nutrition therapy relating
237	237	to diet, caloric intake, and diabetes mana gement, but
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289	289	excluding programs the only purpose of which are
290	290	weight reduction, shall be li mited to the following:
291	291	(1) visits medically necessary upon the diagnosis of
292	292	diabetes,
293	293	(2) a physician diagnosis which represents a
294	294	significant change in the symptoms or condition
295	295	of the patient making medically ne cessary changes
296	296	in the self-management of the patient, and
297	297	(3) visits when reeducation or refresher training is
298	298	medically necessary;
299	299	provided, however, payment for the cov erage required for diabetes
300	300	self-management training pursuant to the provisions of th is section
301	301	shall be required only upon cer tification by the health care
302	302	provider providing the training that the patient has successfully
303	303	completed diabetes self -management training.
304	304	4. Diabetes self-management training shall be supervised by a
305	305	licensed physician or other licensed health care pr ovider legally
306	306	authorized to prescribe under the laws of this state. Diabetes
307	307	self-management training may be provided by the phy sician or other
308	308	appropriately registe red, certified, or licensed health care
309	309	professional as part of an office visit for diabe tes diagnosis or
310	310	treatment. Training provided by appropriately registered,
311	311	certified, or licensed health care professionals may b e provided in
312	312	group settings where pr acticable.
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364	364	5. Coverage for diabetes self -management training and training
365	365	related to medical nutrition therapy, when provided by a registered,
366	366	certified, or licensed health care professional, shall also include
367	367	home visits when medically necessary and sha ll include instruction
368	368	in medical nutrition ther apy only by a licensed registered dietic ian
369	369	or licensed certified nutritionist when authorized by the
370	370	supervising physician of the patient when medically necessary.
371	371	6. Coverage Except as provided in paragrap h 7 of this
372	372	subsection, coverage may be subject to the same annual deductibles
373	373	or coinsurance as may be deemed appropriate and as are is consistent
374	374	with those established for other covered benefits within a given
375	375	policy.
376	376	7. Any health benefit plan, as defined pursuant to Section
377	377	6060.4 of this title, that provides coverage for insulin pursuant to
378	378	this section shall cap the t otal amount that a cov ered person is
379	379	required to pay for insulin at an amount not to exceed Thirty
380	380	Dollars ($30.00) Twenty-five Dollars ($25.00) per thirty-day supply
381	381	or Ninety Dollars ($90.00) per ninety-day supply of insulin for each
382	382	covered insulin prescription, regardless of the a mount or type of
383	383	insulin needed to fill the prescription or prescriptions of the
384	384	covered person. If an FDA-approved diabetes equipment or supply
385	385	product cost exceeds Thirty-five Dollars ($35.00), the health
386	386	benefit plan shall cap the total amount that an insured is required
387	387	to pay for a thirty-day supply at an amount not to exceed Thirty-
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439	439	five Dollars ($35.00). Provided, however, in the event that the
440	440	cost of the thirty-day supply, ninety-day supply, or FDA-approved
441	441	diabetes equipment or supply product is less than the copayment cap
442	442	pursuant to this paragraph, a health benefit plan shall reduce the
443	443	cost-sharing amount of an insured to the lesser assigned copayment
444	444	of the supply or product to the insured.
445	445	a. Nothing in this paragraph shall prev ent a health
446	446	benefit plan from reducing the cos t-sharing of a
447	447	covered person to an a mount less than Thirty Dollars
448	448	($30.00) per thirty-day supply or Ninety Dollars
449	449	($90.00) per ninety-day supply.
450	450	b. The Insurance Commissioner shall ensure all health
451	451	benefit plans comply with the requirements of this
452	452	paragraph.
453	453	c. b. The Commissioner may promulgate rules as ne cessary to
454	454	implement and administer the requirements of this
455	455	paragraph and to align with federal requirements.
456	456	B. 1. Health benefit plans shall not reduce or eliminate
457	457	coverage due to the requirements of this section.
458	458	2. Enforcement of the provisions of this act section shall be
459	459	performed by the Insurance Department and the State Department of
460	460	Health.
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512	512	C. As used in this section, “health benefit plan” means any
513	513	plan or arrangement as d efined in subsection C of Section 6060.4 of
514	514	this title.
515	515	SECTION 2. This act shall become effective November 1, 2023.
516	516
517	517	59-1-1197 RD 1/4/2023 3:35:13 PM

Oklahoma 2023 Regular Session

Oklahoma Senate Bill SB142 Compare Versions