2025 -- H 5026 ======== LC000511 ======== 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 ____________ 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 LC000511 - 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, 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 ======== LC000511 ======== LC000511 - Page 7 of 7 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 ======== LC000511 ========