REPORT TITLE: 
Diabetes Outpatient Coverage


DESCRIPTION:
Requires all individual accident and sickness health care
policies providing health care coverage, and all group health
care contracts issued by health maintenance organizations and
mutual benefit societies, to cover outpatient diabetes self-
management training, education, equipment, and supplies.
(HB2392 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2392
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 2000                                
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
 
20 dramatically lower the incidence of complications, increase life
 

 
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 1 expectancy, and significantly enhance the quality of life of
 
 2 persons with diabetes.  In addition, studies show that providing
 
 3 persons with diabetes with the appropriate supplies and training
 
 4 for self-management results in a decrease in health care services
 
 5 utilization and costs.  Hawaii fails to recover these cost
 
 6 savings, however, because most health plans only provide coverage
 
 7 for equipment and supplies, and do not cover diabetes self-
 
 8 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, other than an accident-only, specified disease, hospital
 
21 indemnity, medicare supplement, long-term care, or other limited
 
22 benefit health insurance policy, that is issued or renewed in
 
23 this state on or after December 31,     , shall provide coverage
 

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
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 1           of the National Certification Board for Diabetic
 
 2           Educators and has completed a course in diabetes
 
 3           education and training or has been certified as a
 
 4           diabetes educator;
 
 5      (2)  Be based upon a diabetes program recognized by the
 
 6           American Diabetes Association or a diabetes program
 
 7           with a curriculum approved by the department of health,
 
 8           the American Diabetes Association-Hawaii area, and the
 
 9           Hawaii Association of Diabetes Educators;
 
10      (3)  Include medically necessary visits:
 
11           (A)  For persons who are newly diagnosed or have
 
12                received no prior diabetes education;
 
13           (B)  Following a physician diagnosis that represents a
 
14                significant change in the patient's symptoms or
 
15                condition that warrants changes in self-
 
16                management; and
 
17           (C)  When reeducation or refresher training is
 
18                prescribed by a health care practitioner with
 
19                prescribing authority;
 
20           and
 
21      (4)  Include medical nutrition therapy provided by a
 
22           dietician.
 

 
 
 
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 1      (d)  For purposes of this section:
 
 2      "Diabetes equipment and supplies" means medically necessary
 
 3 equipment and supplies, prescribed by a licensed physician, or
 
 4 advanced practice registered nurse with prescriptive authority,
 
 5 including:
 
 6      (1)  One blood glucose monitor per year, or if medically
 
 7           necessary as recommended by a physician;
 
 8      (2)  Blood glucose monitors for the legally blind;
 
 9      (3)  Test strips for glucose monitors;
 
10      (4)  Visual reading and urine testing strips;
 
11      (5)  Insulin preparations and glucagon;
 
12      (6)  Insulin cartridges;
 
13      (7)  Insulin cartridges for the legally blind;
 
14      (8)  Drawing up devices and monitors for the visually
 
15           impaired;
 
16      (9)  Injection aids;
 
17     (10)  Syringes and lancets, including automatic lancing
 
18           devices;
 
19     (11)  Prescribed oral agents for controlling blood sugar that
 
20           are included on the plan formulary unless deemed
 
21           medically necessary by a physician;
 
22     (12)  Podiatric services and appliances as defined by
 
23           medicare for the prevention of complications associated
 
24           with diabetes; and
 

 
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 1     (13)  Any other device, medication, equipment, or supply for
 
 2           which coverage is required under medicare from and
 
 3           after January 1, 1999 (and is effective six months
 
 4           after the coverage is required under medicare)."
 
 5     SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended
 
 6 by adding a new section to article 1 to be appropriately
 
 7 designated and to read as follows:
 
 8     "§432:1-       Diabetes coverage.  All individual and group
 
 9 health care contracts under this chapter shall provide, to the
 
10 extent provided under section 431:10A-   , coverage for
 
11 outpatient diabetes self-management training, education,
 
12 equipment, and supplies."
 
13     SECTION 4.  Section 432D-23, Hawaii Revised Statutes, is
 
14 amended to read as follows:
 
15     "§432D-23  Required provisions and benefits.  Notwithstanding
 
16 any provision of law to the contrary, each policy, contract,
 
17 plan, or agreement issued in the State after January 1, 1995, by
 
18 health maintenance organizations pursuant to this chapter, shall
 
19 include benefits provided in sections 431:10-212, 431:10A-115,
 
20 431:10A-115.5, 431:10A-116, 431:10A-116.5, 431:10A-116.6,
 
21 431:10A-119, [and] 431:10-120,and 431:10A-     , and chapter
 
22 431M."
 

 
 
 
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 1     SECTION 5.  Notwithstanding sections 23-51 and 23-52, Hawaii
 
 2 Revised Statutes, or any other law to the contrary, it shall not
 
 3 be necessary for the legislature to pass concurrent resolutions
 
 4 requesting the auditor to prepare and submit an impact assessment
 
 5 report on providing coverage for outpatient diabetes self-
 
 6 management training, education, equipment, and supplies for this
 
 7 Act.
 
 8     SECTION 6.  Statutory material to be repealed is bracketed.
 
 9 New statutory material is underscored.
 
10     SECTION 7.  This Act shall take effect on                 .