| 39 | | - | [ health insurance - diabetes - effective date ] |
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| 63 | + | AS INTRODUCED |
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| 64 | + | |
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| 65 | + | An Act relating to health insurance; amending 36 O.S. |
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| 66 | + | 2021, Section 6060.2, as amended by Section 1, |
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| 67 | + | Chapter 199, O.S.L. 2022 (36 O.S. Supp. 2022, Section |
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| 68 | + | 6060.2), which relates to treatment of diabetes; |
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| 69 | + | requiring certain high deductible health plans to |
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| 70 | + | allow insured to set aside certain moni es for certain |
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| 71 | + | purpose; and providing an effe ctive date. |
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| 40 | 72 | | |
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| 41 | 73 | | |
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| 42 | 74 | | |
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| 43 | 75 | | |
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| 44 | 76 | | |
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| 45 | 77 | | BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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| 46 | 78 | | SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, as |
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| 47 | 79 | | amended by Section 1, Chapter 199, O.S.L. 2022 (36 O.S. Supp. 2 022, |
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| 48 | 80 | | Section 6060.2), is amended to r ead as follows: |
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| 49 | 81 | | Section 6060.2. A. 1. Every health benefit plan issued or |
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| 50 | 82 | | renewed on or after November 1, 1996, shall, subject to the terms of |
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| 51 | 83 | | the policy contract or agreement, i nclude coverage for the following |
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| 52 | 84 | | equipment, supplies and related services for the treatment of Type |
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| 53 | 85 | | I, Type II, and gestationa l diabetes, when medically necessary and |
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| 54 | 86 | | when recommended or prescribed by a physician or other license d |
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| 55 | 87 | | health care provider leg ally authorized to prescribe under the laws |
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| 56 | 88 | | of this state: |
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| 88 | 144 | | e. insulin, |
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| 89 | 145 | | f. injection aids, |
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| 90 | 146 | | g. cartridges for the legally blind, |
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| 91 | 147 | | h. syringes, |
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| 92 | 148 | | i. insulin pumps and appurtenances thereto, |
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| 93 | 149 | | j. insulin infusion devices, |
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| 94 | 150 | | k. oral agents for controlling blood sugar, and |
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| 95 | 151 | | l. podiatric appliances for prevention of complications |
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| 96 | 152 | | associated with diabetes. |
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| 97 | 153 | | 2. The State Board of Health shall develop and annually update, |
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| 98 | 154 | | by rule, a list of addi tional diabetes equipment, related supplies |
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| 99 | 155 | | and health care provider services that are medically necessary for |
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| 100 | 156 | | the treatment of diabetes, for which coverag e shall also be |
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| 101 | 157 | | included, subject to the terms of the policy, contract, or |
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| 102 | 158 | | agreement, if the equipmen t and supplies have been approved by the |
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| 103 | 159 | | federal Food and Drug Administration (FDA). Additional FDA -approved |
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| 104 | 160 | | diabetes equipment and related supplies, and health care provider |
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| 105 | 161 | | services shall be determined in consultation with a national |
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| 106 | 162 | | diabetes association affiliated with this state, and at least three |
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| 138 | 218 | | a. podiatric health care provider services as are deemed |
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| 139 | 219 | | medically necessary to preven t complications from |
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| 140 | 220 | | diabetes, and |
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| 141 | 221 | | b. diabetes self-management training. As used in this |
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| 142 | 222 | | subparagraph, “diabetes self-management training” |
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| 143 | 223 | | means instruction in an inpatient or outpatient |
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| 144 | 224 | | setting which enables diabetic patients to understand |
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| 145 | 225 | | the diabetic management process and daily management |
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| 146 | 226 | | of diabetic therapy as a method of avoiding frequent |
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| 147 | 227 | | hospitalizations and complications. Diabetes self- |
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| 148 | 228 | | management training shall comply with standards |
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| 149 | 229 | | developed by the State Board of Health in consultation |
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| 150 | 230 | | with a national diabetes association affiliated with |
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| 151 | 231 | | this state and at least three medical directors of |
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| 152 | 232 | | health benefit plans selected by th e State Department |
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| 153 | 233 | | of Health. Coverage for diabetes self-management |
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| 154 | 234 | | training, including medical nutrition therapy relating |
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| 155 | 235 | | to diet, caloric intake, and diabetes management, but |
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| 156 | 236 | | excluding programs the only purpose of which are |
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| 157 | 237 | | weight reduction, shall be li mited to the following: |
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| 189 | 293 | | of the patient making medically necessary changes |
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| 190 | 294 | | in the self-management of the patient, and |
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| 191 | 295 | | (3) visits when reeducation or refresher training is |
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| 192 | 296 | | medically necessary; |
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| 193 | 297 | | provided, however, payment for the c overage required for diabetes |
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| 194 | 298 | | self-management training pursuant to the provisions of this section |
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| 195 | 299 | | shall be required only upon cer tification by the health care |
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| 196 | 300 | | provider providing the training that the pati ent has successfully |
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| 197 | 301 | | completed diabetes self -management training. |
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| 198 | 302 | | 4. Diabetes self-management training shall be supervised by a |
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| 199 | 303 | | licensed physician or othe r licensed health care pr ovider legally |
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| 200 | 304 | | authorized to prescribe under the laws of this state. Diabet es |
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| 201 | 305 | | self-management training may be provided by the p hysician or other |
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| 202 | 306 | | appropriately registered, certified, or licensed health care |
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| 203 | 307 | | professional as part of an office visit for diabe tes diagnosis or |
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| 204 | 308 | | treatment. Training provided by appropriately registered, |
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| 205 | 309 | | certified, or licensed health care professionals may be provided in |
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| 206 | 310 | | group settings where practicable. |
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| 207 | 311 | | 5. Coverage for diabetes self -management training an d training |
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| 208 | 312 | | related to medical nutrition therapy, when provided by a registered, |
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| 239 | 367 | | or licensed certified nutritionist when authorized by the |
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| 240 | 368 | | supervising physician of the patient when medically necessary. |
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| 241 | 369 | | 6. Coverage may be subject to the same annual deductibles or |
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| 242 | 370 | | coinsurance as may be deemed appropriate and as are consistent with |
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| 243 | 371 | | those established for other covered benefits within a given policy. |
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| 244 | 372 | | 7. Any health benefit plan, as defined pursuant to Section |
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| 245 | 373 | | 6060.4 of this title, that provides coverage for insulin pursuant to |
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| 246 | 374 | | this section shall cap the t otal amount that a cov ered person is |
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| 247 | 375 | | required to pay for insulin at an amount not to exceed Thirty |
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| 248 | 376 | | Dollars ($30.00) per thirty-day supply or Ninety Dollars ($90. 00) |
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| 249 | 377 | | per ninety-day supply of insulin for each covered insulin |
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| 250 | 378 | | prescription, regardless of the a mount or type of insul in needed to |
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| 251 | 379 | | fill the prescription or prescriptions of the covered person. |
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| 252 | 380 | | a. Nothing in this paragraph shall prev ent a health |
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| 253 | 381 | | benefit plan from reducing the cost -sharing of a |
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| 254 | 382 | | covered person to an amount less than Thirty Dolla rs |
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| 255 | 383 | | ($30.00) per thirty-day supply or Ninety Dollars |
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| 256 | 384 | | ($90.00) per ninety-day supply. |
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| 257 | 385 | | b. The Insurance Commissioner sha ll ensure all health |
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| 258 | 386 | | benefit plans comply with the requirements of this |
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| 259 | 387 | | paragraph. |
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| 290 | 442 | | 8. Starting on or after the effective date of this act , any |
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| 291 | 443 | | high deductible health plan, as defined pursuant to Section 6060.1 5 |
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| 292 | 444 | | of this title, that is issued, renewed, or delivered in this state |
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| 293 | 445 | | by a private insurer pursuant to this section shall allow an insured |
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| 294 | 446 | | to set aside funds on a tax-free basis, up to the contribution limit |
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| 295 | 447 | | provided in Section 223 of the Internal Revenue Code, as amended, to |
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| 296 | 448 | | pay for out-of-pocket medical expens es related to diabetes treatment |
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| 297 | 449 | | and care under this section . |
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| 298 | 450 | | B. 1. Health benefit plans shall not reduce or elim inate |
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| 299 | 451 | | coverage due to the requirements of this section. |
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| 300 | 452 | | 2. Enforcement of the provisions of this act section and |
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| 301 | 453 | | Section 1307.2 of Title 74 of the Oklaho ma Statutes shall be |
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| 302 | 454 | | performed by the Insurance Department and the State Department of |
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| 303 | 455 | | Health. |
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| 304 | 456 | | C. As used in this section, “health benefit plan” means any |
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| 305 | 457 | | plan or arrangement as defined in subsection C of Section 6060.4 of |
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| 306 | 458 | | this title. |
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| 307 | 459 | | SECTION 2. This act shall become effective November 1, 2023. |
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