REPORT TITLE: 
Diabetes Outpatient Coverage


DESCRIPTION:
Mandates coverage under most health insurance policies and
contracts for diabetes outpatient self-management training,
education, equipment, and supplies if it is found to be
medically necessary and prescribed by a health care professional
authorized to prescribe. (SB2657 HD2) 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2657
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 2000                                H.D. 2
STATE OF HAWAII                                            
                                                             
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                     A BILL FOR AN ACT

RELATING TO HEALTH.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 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 persons with diabetes results directly in a
 
17 significant reduction in both the economic and human devastation
 
18 wrought by the disease.  There is ample evidence that tight
 
19 control of blood sugar levels through patient self-management can
 

 
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 1 dramatically lower the incidence of complications, increase life
 
 2 expectancy, and significantly enhance the quality of life of
 
 3 persons with diabetes.  In addition, studies show that providing
 
 4 individuals with diabetes with the appropriate supplies and
 
 5 training for self-management results in a decrease in health care
 
 6 services utilization and costs.  Hawaii fails to recover these
 
 7 cost savings, however, because most health plans only provide
 
 8 coverage for equipment and supplies, and do not cover diabetes
 
 9 self-management education and training.
 
10      The purpose of this Act is to require all individual and
 
11 group accident and sickness health care policies providing health
 
12 care coverage, and all individual and group health care contracts
 
13 issued by health maintenance organizations and mutual benefit
 
14 societies, to provide coverage for outpatient diabetes self-
 
15 management training, education, equipment, and supplies.
 
16      SECTION 2.  Chapter 413, Hawaii Revised Statutes, is amended
 
17 by adding a new section to article 10A to be appropriately
 
18 designated to read as follows:
 
19      "431:10A-    Coverage for diabetes.  Each policy of
 
20 accident and sickness insurance providing coverage for health
 
21 care, other than an accident-only, specified disease, hospital
 
22 indemnity, medicare supplement, long-term care, or other limited
 
23 benefit health insurance policy, that is issued or renewed in
 

 
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 1 this State, shall provide coverage for outpatient diabetes self-
 
 2 management training, education, equipment, and supplies, if:
 
 3      (1)  The equipment, supplies, training, and education are
 
 4           medically necessary; and
 
 5      (2)  The equipment, supplies, training, and education are
 
 6           prescribed by a health care professional authorized to
 
 7           prescribe."
 
 8      SECTION 3.  Chapter 423, Hawaii Revised Statutes, is amended
 
 9 by adding a new section to article 1 to be appropriately
 
10 designated and to read as follows:
 
11      "432:1-    Diabetes coverage.  All group health care
 
12 contracts under this chapter shall provide, to the extent
 
13 provided under section 431:10A-   , coverage for outpatient
 
14 diabetes self-management training, education, equipment, and
 
15 supplies."
 
16      SECTION 4.  Section 423D-32, Hawaii Revised Statutes, is
 
17 amended to read as follows:
 
18      "432D-23  Required provisions and benefits.
 
19 Notwithstanding any provision of law to the contrary, each
 
20 policy, contract, plan, or agreement issued in the State after
 
21 January 1, 1995, by health maintenance organizations pursuant to
 
22 this chapter, shall include benefits provided in sections
 
23 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
24 431:10A-116.5, 431:10A-116.6, [and] 431:10A-119, [and] 431:10A-
 
25 120, and 431:10A-   , and chapter 431M."
 

 
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 1      SECTION 5.  Each insurer, health maintenance organization,
 
 2 and mutual benefit society required to provide coverage for
 
 3 outpatient diabetes self-management training, education,
 
 4 equipment, and supplies is requested to conduct a study of their
 
 5 respective diabetes coverages.  The study should be completed and
 
 6 a report made to the legislature no later than twenty days prior
 
 7 to the convening of the regular session of 2003.  The study
 
 8 should evaluate:
 
 9      (1)  The effectiveness of and any cost savings from a
 
10           continuum of care utilizing a systematic approach to
 
11           diabetes disease management; and
 
12      (2)  The quality of care delivered by providers of diabetes
 
13           self-management, including their levels of training and
 
14           whether or not they are certified in diabetes education
 
15           according to established national standards.
 
16      SECTION 6.  Statutory material to be repealed is bracketed.
 
17 New statutory material is underscored.
 
18      SECTION 7.  This Act shall take effect on July 1, 2001.