Rhode Island 2025 2025 Regular Session

Rhode Island House Bill H5026 Introduced / Bill

Filed 01/10/2025

                     
 
 
 
2025 -- H 5026 
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LC000511 
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S T A T E O F R H O D E I S L A N D 
IN GENERAL ASSEMBLY 
JANUARY SESSION, A.D. 2025 
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A N   A C T 
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES 
Introduced By: Representatives Kennedy, Diaz, Azzinaro, Donovan, Kazarian, Edwards, 
Serpa, O'Brien, Morales, and Ackerman 
Date Introduced: January 10, 2025 
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   
 
 
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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, 2026, 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 savings 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 that provides medical coverage that includes coverage for 29 
physician services in a physician’s office, and every policy that 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   
 
 
LC000511 - 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 diagnosis of diabetes, where 10 
a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates 11 
changes in a patient’s self-management, or where reeducation or refresher training is necessary. 12 
This education, when medically necessary and prescribed by a physician, may be provided only by 13 
the physician or upon his or her referral by an appropriately licensed and certified healthcare 14 
provider and may be conducted in group settings. Coverage for self-management education and 15 
education relating to medical nutrition therapy shall also include home visits when medically 16 
necessary. 17 
(b) Benefit plans offered by a hospital service corporation may impose copayment or 18 
deductibles, or both, for the benefits mandated by this chapter, however, in no instance shall the 19 
copayment or deductible amount be greater than the copayment or deductible amount imposed for 20 
other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 21 
be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 22 
each insurer, hospital, or medical service corporation, or health maintenance organization. 23 
(c) Commencing January 1, 2026, 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 savings 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   
 
 
LC000511 - 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 that provides medical coverage that includes coverage for 3 
physician services in a physician’s office, and every policy that 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 diagnoses a significant change in the patient’s symptoms or conditions 19 
that necessitates changes in a patient’s self-management, or where reeducation or refresher training 20 
is necessary. This education, when medically necessary and prescribed by a physician, may be 21 
provided only by the physician or, upon his or her referral, to an appropriately licensed and certified 22 
healthcare provider, and may be conducted in group settings. Coverage for self-management 23 
education and education relating to medical nutrition therapy shall also include home visits when 24 
medically necessary. 25 
(b) Benefit plans offered by a medical service corporation may impose copayment or 26 
deductibles or both for the benefits mandated by this chapter, however, in no instance shall the 27 
copayment or deductible amount be greater than the copayment or deductible amount imposed for 28 
other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 29 
be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 30 
each insurer, hospital, or medical service corporation, or health maintenance organization. 31 
(c) Commencing January 1, 2026, 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   
 
 
LC000511 - 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 savings 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 that provides medical coverage that includes coverage for 11 
physician services in a physician’s office and every policy that 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 that necessitates 27 
changes in a patient’s self-management, or where reeducation or refresher training is necessary. 28 
This education, when medically necessary and prescribed by a physician, may be provided only by 29 
the physician or, upon his or her referral to an appropriately licensed and certified healthcare 30 
provider and may be conducted in group settings. Coverage for self-management education and 31 
education relating to medical nutrition therapy shall also include home visits when medically 32 
necessary. 33 
(b) Benefit plans offered by a health maintenance organization may impose copayment or 34   
 
 
LC000511 - Page 6 of 7 
deductibles, or both, 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, 2026, 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 savings 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 on and after January 1, 2026, when the health insurance plan for employees 18 
of the State of Rhode Island is purchased or renewed by the director of administration pursuant to 19 
§ 36-12-6, the plan shall provide for the coverage of equipment and supplies for insulin 20 
administration and glucose monitoring, and shall have a cap on the amount that a covered person 21 
is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per 22 
a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than 23 
thirty (30) days. Coverage for such equipment and supplies shall not be subject to any annual 24 
deductible. If the application of the cap to a specific item of equipment or supply before a covered 25 
person has met their plan's deductible would result in health savings account ineligibility under 26 26 
U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the 27 
covered person has met their plan's deductible. 28 
SECTION 6. This act shall take effect on January 1, 2026. 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, 2026. 5 
This act would take effect on January 1, 2026. 6 
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LC000511 
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