Rhode Island 2023 Regular Session

Rhode Island House Bill H5281 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- H 5281
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7	7	LC001061
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Representatives Kennedy, Kazarian, Edwards, Diaz, Azzinaro, Serpa,
17	17	Morales, McEntee, Ackerman, and O'Brien
18	18	Date Introduced: February 01, 2023
19	19	Referred To: House Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 27-18-38 of the General Laws in Chapter 27-18 entitled "Accident 1
24	24	and Sickness Insurance Policies" is hereby amended to read as follows: 2
25	25	27-18-38. Diabetes treatment. 3
26	26	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 4
27	27	for delivery or renewed in this state which provides medical coverage that includes coverage for 5
28	28	physician services in a physician’s office, and every policy which provides major medical or similar 6
29	29	comprehensive-type coverage, except for supplemental policies which only provide coverage for 7
30	30	specified diseases and other supplemental policies, shall include coverage for the following 8
31	31	equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, 9
32	32	and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose 10
33	33	monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or 11
34	34	visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and 12
35	35	appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar 13
36	36	and therapeutic/molded shoes for the prevention of amputation. 14
37	37	(b) Upon the approval of new or improved diabetes equipment and supplies by the Food 15
38	38	and Drug Administration, all policies governed by this section shall guarantee coverage of new 16
39	39	diabetes equipment and supplies when medically appropriate and prescribed by a physician. These 17
40	40	policies shall also include coverage, when medically necessary, for diabetes self-management 18
41	41	education to ensure that persons with diabetes are instructed in the self-management and treatment 19
42	42
43	43
44	44	LC001061 - Page 2 of 7
45	45	of their diabetes, including information on the nutritional management of diabetes. The coverage 1
46	46	for self-management education and education relating to medical nutrition therapy shall be limited 2
47	47	to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a 3
48	48	significant change in the patient’s symptoms or conditions which necessitate changes in a patient’s 4
49	49	self-management, or where reeducation or refresher training is necessary. This education when 5
50	50	medically necessary and prescribed by a physician, may be provided only by the physician or, upon 6
51	51	his or her referral to an appropriately licensed and certified health care provider and may be 7
52	52	conducted in group settings. Coverage for self-management education and education relating to 8
53	53	medical nutrition therapy shall also include home visits when medically necessary. 9
54	54	(c) Benefit plans offered by an insurer may impose co-payment and/or deductibles for the 10
55	55	benefits mandated by this chapter; however, in no instance shall the co-payment or deductible 11
56	56	amount be greater than the co-payment or deductible amount imposed for other supplies, equipment 12
57	57	or physician office visits. Benefits for services under this section shall be reimbursed in accordance 13
58	58	with the respective principles and mechanisms of reimbursement for each insurer, hospital, or 14
59	59	medical service corporation, or health maintenance organization. 15
60	60	(d) Commencing January 1, 2024, coverage for equipment and supplies for insulin 16
61	61	administration and glucose monitoring shall have a cap on the amount that a covered person is 17
62	62	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 18
63	63	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 19
64	64	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 20
65	65	If the application of the cap to a specific item of equipment or supply before a covered person has 21
66	66	met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 22
67	67	223, then the cap would only apply to that specific item of equipment or supply after the covered 23
68	68	person has met their plan's deductible. 24
69	69	SECTION 2. Section 27-19-35 of the General Laws in Chapter 27-19 entitled "Nonprofit 25
70	70	Hospital Service Corporations" is hereby amended to read as follows: 26
71	71	27-19-35. Diabetes treatment. 27
72	72	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 28
73	73	for delivery or renewed in this state which provides medical coverage that includes coverage for 29
74	74	physician services in a physician’s office, and every policy which provides major medical or similar 30
75	75	comprehensive-type coverage, shall include coverage for the following equipment and supplies for 31
76	76	the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 32
77	77	medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 33
78	78	monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, 34
79	79
80	80
81	81	LC001061 - Page 3 of 7
82	82	injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the 1
83	83	pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded 2
84	84	shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment 3
85	85	and supplies by the Food and Drug Administration, all policies governed by this chapter shall 4
86	86	guarantee coverage of new diabetes equipment and supplies when medically appropriate and 5
87	87	prescribed by a physician. The policies shall also include coverage, when medically necessary, for 6
88	88	diabetes self-management education to ensure that persons with diabetes are instructed in the self-7
89	89	management and treatment of their diabetes, including information on the nutritional management 8
90	90	of diabetes. The coverage for self-management education and education relating to medical 9
91	91	nutrition therapy shall be limited to medically necessary visits upon the diagnoses of diabetes, 10
92	92	where a physician diagnosis a significant change in the patient’s symptoms or conditions which 11
93	93	necessitate changes in a patient’s self-management, or where reeducation or refresher training is 12
94	94	necessary. This education, when medically necessary and prescribed by a physician, may be 13
95	95	provided only by the physician or upon his or her referral by an appropriately licensed and certified 14
96	96	health care provider and may be conducted in group settings. Coverage for self-management 15
97	97	education and education relating to medical nutrition therapy shall also include home visits when 16
98	98	medically necessary. 17
99	99	(b) Benefit plans offered by a hospital service corporation may impose copayment and/or 18
100	100	deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment 19
101	101	or deductible amount be greater than the copayment or deductible amount imposed for other 20
102	102	supplies, equipment, or physician office visits. Benefits for services under this chapter shall be 21
103	103	reimbursed in accordance with the respective principles and mechanisms of reimbursement for each 22
104	104	insurer, hospital, or medical service corporation, or health maintenance organization. 23
105	105	(c) Commencing January 1, 2024, coverage for equipment and supplies for insulin 24
106	106	administration and glucose monitoring shall have a cap on the amount that a covered person is 25
107	107	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 26
108	108	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 27
109	109	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 28
110	110	If the application of the cap to a specific item of equipment or supply before a covered person has 29
111	111	met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 30
112	112	223, then the cap would only apply to that specific item of equipment or supply after the covered 31
113	113	person has met their plan's deductible. 32
114	114	SECTION 3. Section 27-20-30 of the General Laws in Chapter 27-20 entitled "Nonprofit 33
115	115	Medical Service Corporations" is hereby amended to read as follows: 34
116	116
117	117
118	118	LC001061 - Page 4 of 7
119	119	27-20-30. Diabetes treatment. 1
120	120	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 2
121	121	for delivery or renewed in this state which provides medical coverage that includes coverage for 3
122	122	physician services in a physician’s office, and every policy which provides major medical or similar 4
123	123	comprehensive-type coverage, shall include coverage for the following equipment and supplies for 5
124	124	the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 6
125	125	medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 7
126	126	monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, 8
127	127	injection aids, cartridges for the legally blind, syringes, insulin pumps, and appurtenances to the 9
128	128	pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded 10
129	129	shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment 11
130	130	and supplies by the Food and Drug Administration, all policies governed by this chapter shall 12
131	131	guarantee coverage of new diabetes equipment and supplies when medically appropriate and 13
132	132	prescribed by a physician. These policies shall also include coverage, when medically necessary, 14
133	133	for diabetes self-management education to ensure that persons with diabetes are instructed in the 15
134	134	self-management and treatment of their diabetes, including information on the nutritional 16
135	135	management of diabetes. The coverage for self-management education and education relating to 17
136	136	medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of 18
137	137	diabetes, where a physician diagnosis a significant change in the patient’s symptoms or conditions 19
138	138	which necessitate changes in a patient’s self-management, or where reeducation or refresher 20
139	139	training is necessary. This education, when medically necessary and prescribed by a physician, may 21
140	140	be provided only by the physician or, upon his or her referral, to an appropriately licensed and 22
141	141	certified health care provider, and may be conducted in group settings. Coverage for self-23
142	142	management education and education relating to medical nutrition therapy shall also include home 24
143	143	visits when medically necessary. 25
144	144	(b) Benefit plans offered by a hospital service corporation may impose copayment and/or 26
145	145	deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment 27
146	146	or deductible amount be greater than the copayment or deductible amount imposed for other 28
147	147	supplies, equipment, or physician office visits. Benefits for services under this chapter shall be 29
148	148	reimbursed in accordance with the respective principles and mechanisms of reimbursement for each 30
149	149	insurer, hospital, or medical service corporation, or health maintenance organization. 31
150	150	(c) Commencing January 1, 2024, coverage for equipment and supplies for insulin 32
151	151	administration and glucose monitoring shall have a cap on the amount that a covered person is 33
152	152	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 34
153	153
154	154
155	155	LC001061 - Page 5 of 7
156	156	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 1
157	157	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 2
158	158	If the application of the cap to a specific item of equipment or supply before a covered person has 3
159	159	met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 4
160	160	223, then the cap would only apply to that specific item of equipment or supply after the covered 5
161	161	person has met their plan's deductible. 6
162	162	SECTION 4. Section 27-41-44 of the General Laws in Chapter 27-41 entitled "Health 7
163	163	Maintenance Organizations" is hereby amended to read as follows: 8
164	164	27-41-44. Diabetes treatment. 9
165	165	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 10
166	166	for delivery or renewed in this state which provides medical coverage that includes coverage for 11
167	167	physician services in a physician’s office and every policy which provides major medical or similar 12
168	168	comprehensive-type coverage shall include coverage for the following equipment and supplies for 13
169	169	the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 14
170	170	medically appropriate and prescribed by a physician blood glucose monitors and blood glucose 15
171	171	monitors for the legally blind, test strips for glucose monitors and visual reading, insulin, injection 16
172	172	aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to them, insulin 17
173	173	infusion devices, oral agents for controlling blood sugar and therapeutic/molded shoes for the 18
174	174	prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies 19
175	175	by the Food and Drug Administration, all policies governed by this chapter shall guarantee 20
176	176	coverage of this new diabetes equipment and supplies when medically appropriate and prescribed 21
177	177	by a physician. These policies shall also include coverage, when medically necessary, for diabetes 22
178	178	self-management education to ensure that persons with diabetes are instructed in the self-23
179	179	management and treatment of their diabetes, including information on the nutritional management 24
180	180	of diabetes. This coverage for self-management education and education relating to medical 25
181	181	nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where 26
182	182	a physician diagnoses a significant change in the patient’s symptoms or conditions which 27
183	183	necessitate changes in a patient’s self-management, or where reeducation or refresher training is 28
184	184	necessary. This education, when medically necessary and prescribed by a physician, may be 29
185	185	provided only by the physician or, upon his or her referral to an appropriately licensed and certified 30
186	186	health care provider and may be conducted in group settings. Coverage for self-management 31
187	187	education and education relating to medical nutrition therapy shall also include home visits when 32
188	188	medically necessary. 33
189	189	(b) Benefit plans offered by a health maintenance organization may impose copayment 34
190	190
191	191
192	192	LC001061 - Page 6 of 7
193	193	and/or deductibles for the benefits mandated by this chapter. However, in no instance shall the 1
194	194	copayment or deductible amount be greater than the copayment or deductible amount imposed for 2
195	195	other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 3
196	196	be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 4
197	197	each insurer, hospital, or medical service corporation, or health maintenance organization. 5
198	198	(c) Commencing January 1, 2024, coverage for equipment and supplies for insulin 6
199	199	administration and glucose monitoring shall have a cap on the amount that a covered person is 7
200	200	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 8
201	201	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 9
202	202	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 10
203	203	If the application of the cap to a specific item of equipment or supply before a covered person has 11
204	204	met their plan's deductible would result in health saving account ineligibility under 26 U.S.C. § 12
205	205	223, then the cap would only apply to that specific item of equipment or supply after the covered 13
206	206	person has met their plan's deductible. 14
207	207	SECTION 5. Chapter 36-12 of the General Laws entitled "Insurance Benefits" is hereby 15
208	208	amended by adding thereto the following section: 16
209	209	36-12-2.6. Health insurance benefits - Diabetes treatment. 17
210	210	Commencing when the next health insurance plan for employees of the state of Rhode 18
211	211	Island is purchased or renewed by the director of administration pursuant to § 36-12-6, it shall be 19
212	212	required that coverage for equipment and supplies for insulin administration and glucose 20
213	213	monitoring shall have a cap on the amount that a covered person is required to pay for such 21
214	214	equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) 22
215	215	days, or per item when an item is intended to be used for longer than thirty (30) days. Coverage for 23
216	216	such equipment and supplies shall not be subject to any annual deductible. If the application of the 24
217	217	cap to a specific item of equipment or supply before a covered person has met their plan's deductible 25
218	218	would result in health saving account ineligibility under 26 U.S.C. § 223, then the cap would only 26
219	219	apply to that specific item of equipment or supply after the covered person has met their plan's 27
220	220	deductible. 28
221	221	SECTION 6. This act shall take effect upon passage. 29
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223	223	LC001061
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226	226
227	227	LC001061 - Page 7 of 7
228	228	EXPLANATION
229	229	BY THE LEGISLATIVE COUNCIL
230	230	OF
231	231	A N A C T
232	232	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
233	233	***
234	234	This act would cap the amount that a covered person is required to pay for insulin 1
235	235	administration and glucose monitoring equipment and supplies at twenty-five dollars ($25.00) per 2
236	236	thirty (30) day supply or per item when an item is intended to be used for longer than thirty (30) 3
237	237	days and would prohibit any deductible for the equipment and supplies. The coverage would 4
238	238	commence on January 1, 2024. 5
239	239	This act would take effect upon passage. 6
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241	241	LC001061
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