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SENATE FLOOR VERSION
February 27, 2023
SENATE BILL NO. 143 By: Hicks
[ health insurance - diabetes - effective date ]
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, as
amended by Section 1, Chapter 199, O.S.L. 2022 (36 O.S. Supp. 2 022,
Section 6060.2), is amended to r ead 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, i nclude 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 p hysician or other licensed
health care provider leg ally authorized to prescribe under the laws
of this state:
a. blood glucose monitors,
b. blood glucose monitors to the legally blind,
c. test strips for glucose monitors,
d. visual reading and urine testin g strips,
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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 co mplications
associated with diabetes.
2. The State Board of Health shall develop and annually update,
by rule, a list of addi tional 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 equipmen t and supplies have been approved by the
federal Food and Drug Administration (FDA). Additional FDA -approved
diabetes equipment a nd 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 plans, to be selected by the
State Department of Health.
3. All policies specified in this section shall also include
coverage for:
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a. podiatric health care provider services as are deemed
medically necessary to prevent complications from
diabetes, and
b. diabetes self-management training. As u sed 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 avoi ding 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 with
this state and at least three medic al directors of
health benefit plans selected by th e 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 li mited to the following:
(1) visits medically necessary upon the diagnosis o f
diabetes,
(2) a physician diagnosis which represents a
significant change in the symptoms or condition
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of the patient making med ically 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 provisi ons of this section
shall be required only upon cer tification by the health care
provider providing the training that the pati ent has successfully
completed diabetes self -management training.
4. Diabetes self-management training shall be supervised by a
licensed physician or other licensed health care pr ovider legally
authorized to prescribe under the laws of this state. Diabet es
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 diabe tes 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 se lf-management training and training
related to medical nutrition therapy, when provided by a registered,
certified, or license d health care professional, shall also include
home visits when medically necessary and shall include instruction
in medical nutrition therapy only by a licensed registered dietic ian
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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 b e deemed appropriate and as are consistent with
those established for other covered benefits within a given policy.
7. Any health benefit plan, as defined pursuant to Section
6060.4 of this title, that provides coverage for insulin pursuant to
this section shall cap the total amount that a cov ered 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 insul in needed to
fill the prescription or prescriptions of the covered person.
a. Nothing in this paragraph shall prev ent a health
benefit plan from reducing the cost -sharing of a
covered person to an amount less than Thi rty Dollars
($30.00) per thirty-day supply or Ninety Dollars
($90.00) per ninety-day supply.
b. The Insurance Commissioner sha ll ensure all health
benefit plans comply with the requirements of this
paragraph.
c. The Commissioner may promulgate rules as nec essary to
implement and administer the requirements of this
paragraph and to align with federal requirements.
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8. Starting on or after the effective date of this act , any
high deductible health plan, as defined pursuant to Section 6060.1 5
of this title, that is issued, renewed, or delivered in this state
by a private insurer pursuant to this section shall allow an insured
to set aside funds on a tax-free basis, up to the contribution limit
provided in Section 223 of the Internal Revenue Code, as amended, to
pay for out-of-pocket medical expens es related to diabetes treatment
and care under this section .
B. 1. Health benefit plans shall not reduce or elim inate
coverage due to the requirements of this section.
2. Enforcement of the provisions of this act section and
Section 1307.2 of Title 74 of the Oklaho ma Statutes shall be
performed by the Insurance Department and the State Department of
Health.
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, 2023.
COMMITTEE REPORT BY: COMMITTEE ON FINANCE
February 27, 2023 - DO PASS