§ 27-41-44 - Diabetes treatment. - Rhode Island Statutes

SECTION 27-41-44

   § 27-41-44  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 officeand 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 physicianblood glucose monitors and blood glucose monitors for the legally blind, teststrips for glucose monitors and visual reading, insulin, injection aids,cartridges for the legally blind, syringes, insulin pumps and appurtenances tothem, insulin infusion devices, oral agents for controlling blood sugar andtherapeutic/molded shoes for the prevention of amputation. Upon the approval ofnew or improved diabetes equipment and supplies by the Food and DrugAdministration, all policies governed by this chapter shall guarantee coverageof this 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. This 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 diagnoses 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 an appropriatelylicensed and certified health care provider and may be conducted in groupsettings. Coverage for self-management education and education relating tomedical nutrition therapy shall also include home visits when medicallynecessary.

   (b) Benefit plans offered by a health maintenanceorganization may impose copayment and/or deductibles for the benefits mandatedby this chapter. However, in no instance shall the copayment or deductibleamount be greater than the copayment or deductible amount imposed for othersupplies, equipment, or physician office visits. Benefits for services underthis chapter shall be reimbursed in accordance with the respective principlesand mechanisms of reimbursement for each insurer, hospital, or medical servicecorporation, or health maintenance organization.