§ 27-20-30 - Diabetes treatment. - Rhode Island Statutes

SECTION 27-20-30

   § 27-20-30  Diabetes treatment. – (a) Every individual or group health insurance contract, plan, or policydelivered, issued for delivery or renewed in this state which provides medicalcoverage that includes coverage for physician services in a physician's office,and every policy which provides major medical or similar comprehensive-typecoverage, shall include coverage for the following equipment and supplies forthe treatment of insulin treated diabetes, non-insulin treated diabetes, andgestational diabetes when medically appropriate and prescribed by a physician:blood glucose monitors and blood glucose monitors for the legally blind, teststrips for glucose monitors and/or visual reading, insulin, injection aids,cartridges for the legally blind, syringes, insulin pumps, and appurtenances tothe pumps, insulin infusion devices, and oral agents for controlling bloodsugar and therapeutic/molded shoes for the prevention of amputation. Upon theapproval of new or improved diabetes equipment and supplies by the Food andDrug Administration, all policies governed by this chapter shall guaranteecoverage of new diabetes equipment and supplies when medically appropriate andprescribed by a physician. These policies shall also include coverage, whenmedically necessary, for diabetes self-management education to ensure thatpersons with diabetes are instructed in the self-management and treatment oftheir diabetes, including information on the nutritional management ofdiabetes. The coverage for self-management education and education relating tomedical nutrition therapy shall be limited to medically necessary visits uponthe diagnosis of diabetes, where a physician diagnosis a significant change inthe patient's symptoms or conditions which necessitate changes in a patient'sself-management, or where reeducation or refresher training is necessary. Thiseducation, when medically necessary and prescribed by a physician, may beprovided only by the physician or, upon his or her referral, to anappropriately licensed and certified health care provider, and may be conductedin group settings. Coverage for self-management education and educationrelating to medical nutrition therapy shall also include home visits whenmedically necessary.

   (b) Benefit plans offered by a hospital service corporationmay impose copayment and/or deductibles for the benefits mandated by thischapter, however, in no instance shall the copayment or deductible amount begreater than the copayment or deductible amount imposed for other supplies,equipment, or physician office visits. Benefits for services under this chaptershall be reimbursed in accordance with the respective principles and mechanismsof reimbursement for each insurer, hospital, or medical service corporation, orhealth maintenance organization.