2023 -- H 5281
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LC001061
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S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
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A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Representatives Kennedy, Kazarian, Edwards, Diaz, Azzinaro, Serpa,
Morales, McEntee, Ackerman, and O'Brien
Date Introduced: February 01, 2023
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-18-38 of the General Laws in Chapter 27-18 entitled "Accident 1
and Sickness Insurance Policies" is hereby amended to read as follows: 2
27-18-38. Diabetes treatment. 3
(a) Every individual or group health insurance contract, plan, or policy delivered, issued 4
for delivery or renewed in this state which provides medical coverage that includes coverage for 5
physician services in a physician’s office, and every policy which provides major medical or similar 6
comprehensive-type coverage, except for supplemental policies which only provide coverage for 7
specified diseases and other supplemental policies, shall include coverage for the following 8
equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, 9
and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose 10
monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or 11
visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and 12
appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar 13
and therapeutic/molded shoes for the prevention of amputation. 14
(b) Upon the approval of new or improved diabetes equipment and supplies by the Food 15
and Drug Administration, all policies governed by this section shall guarantee coverage of new 16
diabetes equipment and supplies when medically appropriate and prescribed by a physician. These 17
policies shall also include coverage, when medically necessary, for diabetes self-management 18
education to ensure that persons with diabetes are instructed in the self-management and treatment 19
LC001061 - Page 2 of 7
of their diabetes, including information on the nutritional management of diabetes. The coverage 1
for self-management education and education relating to medical nutrition therapy shall be limited 2
to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a 3
significant change in the patient’s symptoms or conditions which necessitate changes in a patient’s 4
self-management, or where reeducation or refresher training is necessary. This education when 5
medically necessary and prescribed by a physician, may be provided only by the physician or, upon 6
his or her referral to an appropriately licensed and certified health care provider and may be 7
conducted in group settings. Coverage for self-management education and education relating to 8
medical nutrition therapy shall also include home visits when medically necessary. 9
(c) Benefit plans offered by an insurer may impose co-payment and/or deductibles for the 10
benefits mandated by this chapter; however, in no instance shall the co-payment or deductible 11
amount be greater than the co-payment or deductible amount imposed for other supplies, equipment 12
or physician office visits. Benefits for services under this section shall be reimbursed in accordance 13
with the respective principles and mechanisms of reimbursement for each insurer, hospital, or 14
medical service corporation, or health maintenance organization. 15
(d) Commencing January 1, 2024, coverage for equipment and supplies for insulin 16
administration and glucose monitoring shall have a cap on the amount that a covered person is 17
required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 18
supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 19
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 20
If the application of the cap to a specific item of equipment or supply before a covered person has 21
met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 22
223, then the cap would only apply to that specific item of equipment or supply after the covered 23
person has met their plan's deductible. 24
SECTION 2. Section 27-19-35 of the General Laws in Chapter 27-19 entitled "Nonprofit 25
Hospital Service Corporations" is hereby amended to read as follows: 26
27-19-35. Diabetes treatment. 27
(a) Every individual or group health insurance contract, plan, or policy delivered, issued 28
for delivery or renewed in this state which provides medical coverage that includes coverage for 29
physician services in a physician’s office, and every policy which provides major medical or similar 30
comprehensive-type coverage, shall include coverage for the following equipment and supplies for 31
the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 32
medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 33
monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, 34
LC001061 - Page 3 of 7
injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the 1
pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded 2
shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment 3
and supplies by the Food and Drug Administration, all policies governed by this chapter shall 4
guarantee coverage of new diabetes equipment and supplies when medically appropriate and 5
prescribed by a physician. The policies shall also include coverage, when medically necessary, for 6
diabetes self-management education to ensure that persons with diabetes are instructed in the self-7
management and treatment of their diabetes, including information on the nutritional management 8
of diabetes. The coverage for self-management education and education relating to medical 9
nutrition therapy shall be limited to medically necessary visits upon the diagnoses of diabetes, 10
where a physician diagnosis a significant change in the patient’s symptoms or conditions which 11
necessitate changes in a patient’s self-management, or where reeducation or refresher training is 12
necessary. This education, when medically necessary and prescribed by a physician, may be 13
provided only by the physician or upon his or her referral by an appropriately licensed and certified 14
health care provider and may be conducted in group settings. Coverage for self-management 15
education and education relating to medical nutrition therapy shall also include home visits when 16
medically necessary. 17
(b) Benefit plans offered by a hospital service corporation may impose copayment and/or 18
deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment 19
or deductible amount be greater than the copayment or deductible amount imposed for other 20
supplies, equipment, or physician office visits. Benefits for services under this chapter shall be 21
reimbursed in accordance with the respective principles and mechanisms of reimbursement for each 22
insurer, hospital, or medical service corporation, or health maintenance organization. 23
(c) Commencing January 1, 2024, coverage for equipment and supplies for insulin 24
administration and glucose monitoring shall have a cap on the amount that a covered person is 25
required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 26
supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 27
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 28
If the application of the cap to a specific item of equipment or supply before a covered person has 29
met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 30
223, then the cap would only apply to that specific item of equipment or supply after the covered 31
person has met their plan's deductible. 32
SECTION 3. Section 27-20-30 of the General Laws in Chapter 27-20 entitled "Nonprofit 33
Medical Service Corporations" is hereby amended to read as follows: 34
LC001061 - Page 4 of 7
27-20-30. Diabetes treatment. 1
(a) Every individual or group health insurance contract, plan, or policy delivered, issued 2
for delivery or renewed in this state which provides medical coverage that includes coverage for 3
physician services in a physician’s office, and every policy which provides major medical or similar 4
comprehensive-type coverage, shall include coverage for the following equipment and supplies for 5
the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 6
medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 7
monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, 8
injection aids, cartridges for the legally blind, syringes, insulin pumps, and appurtenances to the 9
pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded 10
shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment 11
and supplies by the Food and Drug Administration, all policies governed by this chapter shall 12
guarantee coverage of new diabetes equipment and supplies when medically appropriate and 13
prescribed by a physician. These policies shall also include coverage, when medically necessary, 14
for diabetes self-management education to ensure that persons with diabetes are instructed in the 15
self-management and treatment of their diabetes, including information on the nutritional 16
management of diabetes. The coverage for self-management education and education relating to 17
medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of 18
diabetes, where a physician diagnosis a significant change in the patient’s symptoms or conditions 19
which necessitate changes in a patient’s self-management, or where reeducation or refresher 20
training is necessary. This education, when medically necessary and prescribed by a physician, may 21
be provided only by the physician or, upon his or her referral, to an appropriately licensed and 22
certified health care provider, and may be conducted in group settings. Coverage for self-23
management education and education relating to medical nutrition therapy shall also include home 24
visits when medically necessary. 25
(b) Benefit plans offered by a hospital service corporation may impose copayment and/or 26
deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment 27
or deductible amount be greater than the copayment or deductible amount imposed for other 28
supplies, equipment, or physician office visits. Benefits for services under this chapter shall be 29
reimbursed in accordance with the respective principles and mechanisms of reimbursement for each 30
insurer, hospital, or medical service corporation, or health maintenance organization. 31
(c) Commencing January 1, 2024, coverage for equipment and supplies for insulin 32
administration and glucose monitoring shall have a cap on the amount that a covered person is 33
required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 34
LC001061 - Page 5 of 7
supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 1
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 2
If the application of the cap to a specific item of equipment or supply before a covered person has 3
met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 4
223, then the cap would only apply to that specific item of equipment or supply after the covered 5
person has met their plan's deductible. 6
SECTION 4. Section 27-41-44 of the General Laws in Chapter 27-41 entitled "Health 7
Maintenance Organizations" is hereby amended to read as follows: 8
27-41-44. Diabetes treatment. 9
(a) Every individual or group health insurance contract, plan, or policy delivered, issued 10
for delivery or renewed in this state which provides medical coverage that includes coverage for 11
physician services in a physician’s office and every policy which provides major medical or similar 12
comprehensive-type coverage shall include coverage for the following equipment and supplies for 13
the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 14
medically appropriate and prescribed by a physician blood glucose monitors and blood glucose 15
monitors for the legally blind, test strips for glucose monitors and visual reading, insulin, injection 16
aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to them, insulin 17
infusion devices, oral agents for controlling blood sugar and therapeutic/molded shoes for the 18
prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies 19
by the Food and Drug Administration, all policies governed by this chapter shall guarantee 20
coverage of this new diabetes equipment and supplies when medically appropriate and prescribed 21
by a physician. These policies shall also include coverage, when medically necessary, for diabetes 22
self-management education to ensure that persons with diabetes are instructed in the self-23
management and treatment of their diabetes, including information on the nutritional management 24
of diabetes. This coverage for self-management education and education relating to medical 25
nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where 26
a physician diagnoses a significant change in the patient’s symptoms or conditions which 27
necessitate changes in a patient’s self-management, or where reeducation or refresher training is 28
necessary. This education, when medically necessary and prescribed by a physician, may be 29
provided only by the physician or, upon his or her referral to an appropriately licensed and certified 30
health care provider and may be conducted in group settings. Coverage for self-management 31
education and education relating to medical nutrition therapy shall also include home visits when 32
medically necessary. 33
(b) Benefit plans offered by a health maintenance organization may impose copayment 34
LC001061 - Page 6 of 7
and/or deductibles for the benefits mandated by this chapter. However, in no instance shall the 1
copayment or deductible amount be greater than the copayment or deductible amount imposed for 2
other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 3
be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 4
each insurer, hospital, or medical service corporation, or health maintenance organization. 5
(c) Commencing January 1, 2024, coverage for equipment and supplies for insulin 6
administration and glucose monitoring shall have a cap on the amount that a covered person is 7
required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 8
supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 9
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 10
If the application of the cap to a specific item of equipment or supply before a covered person has 11
met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 12
223, then the cap would only apply to that specific item of equipment or supply after the covered 13
person has met their plan's deductible. 14
SECTION 5. Chapter 36-12 of the General Laws entitled "Insurance Benefits" is hereby 15
amended by adding thereto the following section: 16
36-12-2.6. Health insurance benefits - Diabetes treatment. 17
Commencing when the next health insurance plan for employees of the state of Rhode 18
Island is purchased or renewed by the director of administration pursuant to § 36-12-6, it shall be 19
required that coverage for equipment and supplies for insulin administration and glucose 20
monitoring shall have a cap on the amount that a covered person is required to pay for such 21
equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) 22
days, or per item when an item is intended to be used for longer than thirty (30) days. Coverage for 23
such equipment and supplies shall not be subject to any annual deductible. If the application of the 24
cap to a specific item of equipment or supply before a covered person has met their plan's deductible 25
would result in health saving account ineligibility under 26 U.S.C. § 223, then the cap would only 26
apply to that specific item of equipment or supply after the covered person has met their plan's 27
deductible. 28
SECTION 6. This act shall take effect upon passage. 29
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would cap the amount that a covered person is required to pay for insulin 1
administration and glucose monitoring equipment and supplies at twenty-five dollars ($25.00) per 2
thirty (30) day supply or per item when an item is intended to be used for longer than thirty (30) 3
days and would prohibit any deductible for the equipment and supplies. The coverage would 4
commence on January 1, 2024. 5
This act would take effect upon passage. 6
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LC001061
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