Diabetes Outpatient Coverage

Requires health insurance coverage under accident and sickness
individual policies and group health maintenance organization
and mutual benefit society contracts to include coverage for
diabetes outpatient self-management training and education and
equipment and supplies.

HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                     A BILL FOR AN ACT



 1      SECTION 1.  The legislature finds that approximately ninety
 2 thousand people living in Hawaii have diabetes.  Native Hawaiians
 3 and Asians experience a risk of developing diabetes that is twice
 4 that of the general U.S. population.  Native Hawaiians, compared
 5 to all other racial groups in the state during the years 1989
 6 through 1991, had the highest rate of mortality due to diabetes
 7 and its complications (34.7 out of every one hundred thousand
 8 residents), a rate that was one hundred thirty per cent higher
 9 than that of any other racial group in Hawaii (15.1 out of every
10 one hundred thousand residents).  Of native Hawaiians, those of
11 pure Hawaiian descent had the highest mortality rate (93.3 out of
12 every one hundred thousand residents), a rate that was five
13 hundred eighteen per cent higher than that of any other racial
14 group in the state.
15      The legislature finds that effective outpatient self-
16 management by diabetics results directly in a significant
17 reduction in both the economic and human devastation wrought by
18 the disease.  There is ample evidence that tight control of blood
19 sugar levels through patient self-management can dramatically

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 1 lower the incidence of complications, increase life expectancy,
 2 and significantly enhance the quality of life of diabetics.  In
 3 addition, studies show that providing diabetics with the
 4 appropriate supplies and training for self-management results in
 5 a decrease in health care services utilization and costs.  Hawaii
 6 fails to recover these cost savings, however, because most health
 7 plans only provide coverage for equipment and supplies, and do
 8 not cover diabetes self-management education and training.
 9      The purpose of this Act is to require all individual
10 accident and sickness health care policies providing health care
11 coverage, and all group health care contracts issued by health
12 maintenance organizations and mutual benefit societies, to
13 provide coverage for outpatient diabetes self-management
14 training, education, equipment, and supplies.
15      SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended
16 by adding a new section to article 10A to be appropriately
17 designated to read as follows:
18      "431:10A-      Coverage for diabetes.  (a)  Each policy of
19 accident and sickness insurance providing coverage for health
20 care, that is issued or renewed in this state, shall provide
21 coverage for outpatient diabetes self-management training,
22 education, equipment, and supplies, if:

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 1      (1)  The equipment, supplies, training, and education are
 2           medically necessary;
 3      (2)  The equipment, supplies, training, and education are
 4           prescribed by a health care professional authorized to
 5           prescribe under subsection (b); and
 6      (3)  The outpatient self-management training and education
 7           is provided by a provider with qualifications as set
 8           forth under subsection (c);
 9      (b)  Diabetes equipment, supplies, and outpatient self-
10 management training and education covered under this section
11 shall be prescribed by a licensed physician, advance practice
12 nurse with prescriptive authority, or by any other licensed
13 health care professional who is certified in diabetes by the
14 National Certification Board of Diabetes Educators and who is
15 legally authorized to prescribe.
16      (c)  Diabetes self-management training and education,
17 including medical nutrition training covered under this section
18 shall:
19      (1)  Be provided by a physician, nurse, dietitian,
20           pharmacist, or other licensed health care provider who
21           satisfies the current academic eligibility requirements
22           of the National Certification Board for Diabetic
23           Educators and has completed a course in diabetes

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 1           education and training or has been certified as a
 2           diabetes educator;
 3      (2)  Be based upon a diabetes program recognized by the
 4           American Diabetes Association or a diabetes program
 5           with a curriculum approved by the American Diabetes
 6           Association, the Hawaii State Department of Health, and
 7           the Hawaii Association of Diabetes Educators;
 8      (3)  Include medically necessary visits:
 9             (A)  For persons who are newly diagnosed or have
10                  received no prior diabetes education;
11            (B)   Following a physician diagnosis that represents
12                  a significant change in the patient's symptoms
13                  or condition that warrants changes in self-
14                  management; and
15           (C)    When reeducation or refresher training is
16                  prescribed by a health care practitioner with
17                  prescribing authority;
18           and
19      (4)  Include medical nutrition therapy provided by a
20           licensed nutritionist.
21      (d)  For purposes of this section:
22      "Diabetes equipment and supplies" means medically necessary
23 equipment and supplies, prescribed by a licensed physician or
24 advance practice nurse with prescriptive authority, including:

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 1      (1)  Blood glucose monitors;
 2      (2)  Blood glucose monitors for the legally blind;
 3      (3)  Test strips for glucose monitors;
 4      (4)  Visual reading and urine testing strips;
 5      (5)  Insulin preparations and glucagon;
 6      (6)  Insulin cartridges;
 7      (7)  Insulin cartridges for the legally blind;
 8      (8)  Drawing up devices and monitors for the visually
 9           impaired;
10      (9)  Injection aids;
11     (10)  Syringes and lancets, including automatic lancing
12           devices;
13     (11)  Prescribed oral agents for controlling blood sugar that
14           are included on the plan formulary;
15     (12)  Podiatric appliances for prevention of complications
16           associated with diabetes to the extent coverage is
17           required under medicare; and
18     (13)  Any other device, medication, equipment, or supply for
19           which coverage is required under medicare from and
20           after January 1, 1999 (and is effective six months
21           after the coverage is required under medicare)."
22     SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended
23 by adding a new section to article 1  to be appropriately
24 designated and to read as follows:

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 1     "432:1-       Diabetes coverage.  All individual and group
 2 health care contracts under this chapter shall provide, to the
 3 extent provided under section 431:10A-   , coverage for
 4 outpatient diabetes self-management training, education,
 5 equipment, and supplies."
 6     SECTION 4.  Section 432D-23, Hawaii Revised Statutes, is
 7 amended to read as follows:
 8     "432D-23  Required provisions and benefits.  Notwithstanding
 9 any provision of law to the contrary, each policy, contract,
10 plan, or agreement issued in the State after January 1, 1995, by
11 health maintenance organizations pursuant to this chapter, shall
12 include benefits provided in sections 431:10-212, 431:10A-115,
13 431:10A-115.5, 431:10A-116, 431:10A-116.5, 431:10A-116.6,
14 431:10A-119, [and] 431:10-120,and 431:10A-     , and chapter
15 431M."
16      SECTION 5.  Statutory material to be repealed is bracketed.
17 New statutory material is underscored.
18      SECTION 6.  This Act shall take effect upon its approval.
20                       INTRODUCED BY:  ___________________________