Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0196 Compare Versions

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

Old	New	Differences
1	1
2	2
3	3
4	4
5	5	2025 -- S 0196
6	6	========
7	7	LC000999
8	8	========
9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
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: Senators Murray, Bell, McKenney, Euer, Lauria, and Thompson
17	17	Date Introduced: February 07, 2025
18	18	Referred To: Senate Health & Human Services
19	19
20	20
21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Section 27-18-38 of the General Laws in Chapter 27-18 entitled "Accident 1
23	23	and Sickness Insurance Policies" is hereby amended to read as follows: 2
24	24	27-18-38. Diabetes treatment. 3
25	25	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 4
26	26	for delivery or renewed in this state which provides medical coverage that includes coverage for 5
27	27	physician services in a physician’s office, and every policy which provides major medical or similar 6
28	28	comprehensive-type coverage, except for supplemental policies which only provide coverage for 7
29	29	specified diseases and other supplemental policies, shall include coverage for the following 8
30	30	equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, 9
31	31	and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose 10
32	32	monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or 11
33	33	visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and 12
34	34	appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar 13
35	35	and therapeutic/molded shoes for the prevention of amputation. 14
36	36	(b) Upon the approval of new or improved diabetes equipment and supplies by the Food 15
37	37	and Drug Administration, all policies governed by this section shall guarantee coverage of new 16
38	38	diabetes equipment and supplies when medically appropriate and prescribed by a physician. These 17
39	39	policies shall also include coverage, when medically necessary, for diabetes self-management 18
40	40	education to ensure that persons with diabetes are instructed in the self-management and treatment 19
41	41
42	42
43	43	LC000999 - Page 2 of 7
44	44	of their diabetes, including information on the nutritional management of diabetes. The coverage 1
45	45	for self-management education and education relating to medical nutrition therapy shall be limited 2
46	46	to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a 3
47	47	significant change in the patient’s symptoms or conditions which necessitate changes in a patient’s 4
48	48	self-management, or where reeducation or refresher training is necessary. This education when 5
49	49	medically necessary and prescribed by a physician, may be provided only by the physician or, upon 6
50	50	his or her referral to an appropriately licensed and certified health care provider and may be 7
51	51	conducted in group settings. Coverage for self-management education and education relating to 8
52	52	medical nutrition therapy shall also include home visits when medically necessary. 9
53	53	(c) Benefit plans offered by an insurer may impose co-payment and/or deductibles for the 10
54	54	benefits mandated by this chapter; however, in no instance shall the co-payment or deductible 11
55	55	amount be greater than the co-payment or deductible amount imposed for other supplies, equipment 12
56	56	or physician office visits. Benefits for services under this section shall be reimbursed in accordance 13
57	57	with the respective principles and mechanisms of reimbursement for each insurer, hospital, or 14
58	58	medical service corporation, or health maintenance organization. 15
59	59	(d) Commencing January 1, 2026, coverage for equipment and supplies for insulin 16
60	60	administration and glucose monitoring shall have a cap on the amount that a covered person is 17
61	61	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 18
62	62	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 19
63	63	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 20
64	64	If the application of the cap to a specific item of equipment or supply before a covered person has 21
65	65	met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 22
66	66	223, then the cap would only apply to that specific item of equipment or supply after the covered 23
67	67	person has met their plan's deductible. 24
68	68	SECTION 2. Section 27-19-35 of the General Laws in Chapter 27-19 entitled "Nonprofit 25
69	69	Hospital Service Corporations" is hereby amended to read as follows: 26
70	70	27-19-35. Diabetes treatment. 27
71	71	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 28
72	72	for delivery, or renewed in this state that provides medical coverage that includes coverage for 29
73	73	physician services in a physician’s office, and every policy that provides major medical or similar 30
74	74	comprehensive-type coverage shall include coverage for the following equipment and supplies for 31
75	75	the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 32
76	76	medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 33
77	77	monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, 34
78	78
79	79
80	80	LC000999 - Page 3 of 7
81	81	injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the 1
82	82	pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded 2
83	83	shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment 3
84	84	and supplies by the Food and Drug Administration, all policies governed by this chapter shall 4
85	85	guarantee coverage of new diabetes equipment and supplies when medically appropriate and 5
86	86	prescribed by a physician. The policies shall also include coverage, when medically necessary, for 6
87	87	diabetes self-management education to ensure that persons with diabetes are instructed in the self-7
88	88	management and treatment of their diabetes, including information on the nutritional management 8
89	89	of diabetes. The coverage for self-management education and education relating to medical 9
90	90	nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where 10
91	91	a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates 11
92	92	changes in a patient’s self-management, or where reeducation or refresher training is necessary. 12
93	93	This education, when medically necessary and prescribed by a physician, may be provided only by 13
94	94	the physician or upon his or her referral by an appropriately licensed and certified healthcare 14
95	95	provider and may be conducted in group settings. Coverage for self-management education and 15
96	96	education relating to medical nutrition therapy shall also include home visits when medically 16
97	97	necessary. 17
98	98	(b) Benefit plans offered by a hospital service corporation may impose copayment or 18
99	99	deductibles, or both, for the benefits mandated by this chapter, however, in no instance shall the 19
100	100	copayment or deductible amount be greater than the copayment or deductible amount imposed for 20
101	101	other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 21
102	102	be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 22
103	103	each insurer, hospital, or medical service corporation, or health maintenance organization. 23
104	104	(c) Commencing January 1, 2026, coverage for equipment and supplies for insulin 24
105	105	administration and glucose monitoring shall have a cap on the amount that a covered person is 25
106	106	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 26
107	107	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 27
108	108	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 28
109	109	If the application of the cap to a specific item of equipment or supply before a covered person has 29
110	110	met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 30
111	111	223, then the cap would only apply to that specific item of equipment or supply after the covered 31
112	112	person has met their plan's deductible. 32
113	113	SECTION 3. Section 27-20-30 of the General Laws in Chapter 27-20 entitled "Nonprofit 33
114	114	Medical Service Corporations" is hereby amended to read as follows: 34
115	115
116	116
117	117	LC000999 - Page 4 of 7
118	118	27-20-30. Diabetes treatment. 1
119	119	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 2
120	120	for delivery, or renewed in this state that provides medical coverage that includes coverage for 3
121	121	physician services in a physician’s office, and every policy that provides major medical or similar 4
122	122	comprehensive-type coverage, shall include coverage for the following equipment and supplies for 5
123	123	the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 6
124	124	medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 7
125	125	monitors for the legally blind; test strips for glucose monitors and/or visual reading, insulin, 8
126	126	injection aids, cartridges for the legally blind, syringes, insulin pumps, and appurtenances to the 9
127	127	pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded 10
128	128	shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment 11
129	129	and supplies by the Food and Drug Administration, all policies governed by this chapter shall 12
130	130	guarantee coverage of new diabetes equipment and supplies when medically appropriate and 13
131	131	prescribed by a physician. These policies shall also include coverage, when medically necessary, 14
132	132	for diabetes self-management education to ensure that persons with diabetes are instructed in the 15
133	133	self-management and treatment of their diabetes, including information on the nutritional 16
134	134	management of diabetes. The coverage for self-management education and education relating to 17
135	135	medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of 18
136	136	diabetes, where a physician diagnoses a significant change in the patient’s symptoms or conditions 19
137	137	that necessitates changes in a patient’s self-management, or where reeducation or refresher training 20
138	138	is necessary. This education, when medically necessary and prescribed by a physician, may be 21
139	139	provided only by the physician or, upon his or her referral, to an appropriately licensed and certified 22
140	140	healthcare provider, and may be conducted in group settings. Coverage for self-management 23
141	141	education and education relating to medical nutrition therapy shall also include home visits when 24
142	142	medically necessary. 25
143	143	(b) Benefit plans offered by a medical service corporation may impose copayment or 26
144	144	deductibles or both for the benefits mandated by this chapter, however, in no instance shall the 27
145	145	copayment or deductible amount be greater than the copayment or deductible amount imposed for 28
146	146	other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 29
147	147	be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 30
148	148	each insurer, hospital, or medical service corporation, or health maintenance organization. 31
149	149	(c) Commencing January 1, 2026, coverage for equipment and supplies for insulin 32
150	150	administration and glucose monitoring shall have a cap on the amount that a covered person is 33
151	151	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 34
152	152
153	153
154	154	LC000999 - Page 5 of 7
155	155	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 1
156	156	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 2
157	157	If the application of the cap to a specific item of equipment or supply before a covered person has 3
158	158	met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 4
159	159	223, then the cap would only apply to that specific item of equipment or supply after the covered 5
160	160	person has met their plan's deductible. 6
161	161	SECTION 4. Section 27-41-44 of the General Laws in Chapter 27-41 entitled "Health 7
162	162	Maintenance Organizations" is hereby amended to read as follows: 8
163	163	27-41-44. Diabetes treatment. 9
164	164	(a) Every individual or group health insurance contract, plan, or policy delivered, issued 10
165	165	for delivery, or renewed in this state that provides medical coverage that includes coverage for 11
166	166	physician services in a physician’s office and every policy that provides major medical or similar 12
167	167	comprehensive-type coverage shall include coverage for the following equipment and supplies for 13
168	168	the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when 14
169	169	medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose 15
170	170	monitors for the legally blind, test strips for glucose monitors and visual reading, insulin, injection 16
171	171	aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to them, insulin 17
172	172	infusion devices, oral agents for controlling blood sugar, and therapeutic/molded shoes for the 18
173	173	prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies 19
174	174	by the Food and Drug Administration, all policies governed by this chapter shall guarantee 20
175	175	coverage of this new diabetes equipment and supplies when medically appropriate and prescribed 21
176	176	by a physician. These policies shall also include coverage, when medically necessary, for diabetes 22
177	177	self-management education to ensure that persons with diabetes are instructed in the self-23
178	178	management and treatment of their diabetes, including information on the nutritional management 24
179	179	of diabetes. This coverage for self-management education and education relating to medical 25
180	180	nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where 26
181	181	a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates 27
182	182	changes in a patient’s self-management, or where reeducation or refresher training is necessary. 28
183	183	This education, when medically necessary and prescribed by a physician, may be provided only by 29
184	184	the physician or, upon his or her referral to an appropriately licensed and certified healthcare 30
185	185	provider and may be conducted in group settings. Coverage for self-management education and 31
186	186	education relating to medical nutrition therapy shall also include home visits when medically 32
187	187	necessary. 33
188	188	(b) Benefit plans offered by a health maintenance organization may impose copayment or 34
189	189
190	190
191	191	LC000999 - Page 6 of 7
192	192	deductibles, or both, for the benefits mandated by this chapter. However, in no instance shall the 1
193	193	copayment or deductible amount be greater than the copayment or deductible amount imposed for 2
194	194	other supplies, equipment, or physician office visits. Benefits for services under this chapter shall 3
195	195	be reimbursed in accordance with the respective principles and mechanisms of reimbursement for 4
196	196	each insurer, hospital, or medical service corporation, or health maintenance organization. 5
197	197	(c) Commencing January 1, 2026, coverage for equipment and supplies for insulin 6
198	198	administration and glucose monitoring shall have a cap on the amount that a covered person is 7
199	199	required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a 8
200	200	supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty 9
201	201	(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. 10
202	202	If the application of the cap to a specific item of equipment or supply before a covered person has 11
203	203	met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 12
204	204	223, then the cap would only apply to that specific item of equipment or supply after the covered 13
205	205	person has met their plan's deductible. 14
206	206	SECTION 5. Chapter 36-12 of the General Laws entitled "Insurance Benefits" is hereby 15
207	207	amended by adding thereto the following section: 16
208	208	36-12-2.6. Health insurance benefits - Diabetes treatment. 17
209	209	Commencing on and after January 1, 2026, when the health insurance plan for employees 18
210	210	of the State of Rhode Island is purchased or renewed by the director of administration pursuant to 19
211	211	§ 36-12-6, the plan shall provide for the coverage of equipment and supplies for insulin 20
212	212	administration and glucose monitoring, and shall have a cap on the amount that a covered person 21
213	213	is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per 22
214	214	a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than 23
215	215	thirty (30) days. Coverage for such equipment and supplies shall not be subject to any annual 24
216	216	deductible. If the application of the cap to a specific item of equipment or supply before a covered 25
217	217	person has met their plan's deductible would result in health savings account ineligibility under 26 26
218	218	U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the 27
219	219	covered person has met their plan's deductible. 28
220	220	SECTION 6. This act shall take effect on January 1, 2026. 29
221	221	========
222	222	LC000999
223	223	========
224	224
225	225
226	226	LC000999 - Page 7 of 7
227	227	EXPLANATION
228	228	BY THE LEGISLATIVE COUNCIL
229	229	OF
230	230	A N A C T
231	231	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
232	232	***
233	233	This act would cap the amount that a covered person is required to pay for insulin 1
234	234	administration and glucose monitoring equipment and supplies at twenty-five dollars ($25.00) per 2
235	235	thirty (30) day supply or per item when an item is intended to be used for longer than thirty (30) 3
236	236	days and would prohibit any deductible for the equipment and supplies. The coverage would 4
237	237	commence on January 1, 2026. 5
238	238	This act would take effect on January 1, 2026. 6
239	239	========
240	240	LC000999
241	241	========
242	242