Sec. 3406p.
(1) An insurer providing an expense-incurred hospital, medical, or surgical policy or certificate delivered or issued for delivery in this state and a health maintenance organization shall establish and provide to insureds, enrollees, and participating providers a program to prevent the onset of clinical diabetes. This program for participating providers shall emphasize best practice guidelines to prevent the onset of clinical diabetes and to treat diabetes, including, but not limited to, diet, lifestyle, physical exercise and fitness, and early diagnosis and treatment.
(2) An insurer and a health maintenance organization providing a program pursuant to subsection (1) shall regularly measure the effectiveness of the program by regularly surveying individuals covered by the policy, certificate, or contract. Not later than 2 years after the effective date of the amendatory act that added this section, each insurer and health maintenance organization providing a program pursuant to subsection (1) shall prepare a report containing the results of the survey and shall provide a copy of the report to the department of community health.
(3) An expense-incurred hospital, medical, or surgical policy or certificate delivered or issued for delivery in this state and a health maintenance organization contract shall include coverage for the following equipment, supplies, and educational training for the treatment of diabetes, if determined to be medically necessary and prescribed by an allopathic or osteopathic physician:
(a) Blood glucose monitors and blood glucose monitors for the legally blind.
(b) Test strips for glucose monitors, visual reading and urine testing strips, lancets, and spring-powered lancet devices.
(c) Syringes.
(d) Insulin pumps and medical supplies required for the use of an insulin pump.
(e) Diabetes self-management training to ensure that persons with diabetes are trained as to the proper self-management and treatment of their diabetic condition.
(4) An expense-incurred hospital, medical, or surgical policy or certificate delivered or issued for delivery in this state and a health maintenance organization contract that provides outpatient pharmaceutical coverage directly or by rider shall include the following coverage for the treatment of diabetes, if determined to be medically necessary:
(a) Insulin, if prescribed by an allopathic or osteopathic physician.
(b) Nonexperimental medication for controlling blood sugar, if prescribed by an allopathic or osteopathic physician.
(c) Medications used in the treatment of foot ailments, infections, and other medical conditions of the foot, ankle, or nails associated with diabetes, if prescribed by an allopathic, osteopathic, or podiatric physician.
(5) Coverage under subsection (3) for diabetes self-management training is subject to all of the following:
(a) Is limited to completion of a certified diabetes education program upon occurrence of either of the following:
(i) If considered medically necessary upon the diagnosis of diabetes by an allopathic or osteopathic physician who is managing the patient's diabetic condition and if the services are needed under a comprehensive plan of care to ensure therapy compliance or to provide necessary skills and knowledge.
(ii) If an allopathic or osteopathic physician diagnoses a significant change with long-term implications in the patient's symptoms or conditions that necessitates changes in a patient's self-management or a significant change in medical protocol or treatment modalities.
(b) Shall be provided by a diabetes outpatient training program certified to receive medicaid or medicare reimbursement or certified by the department of community health. Training provided under this subdivision shall be conducted in group settings whenever practicable.
(6) Coverage under this section is not subject to dollar limits, deductibles, or copayment provisions that are greater than those for physical illness generally.
(7) As used in this section, “diabetes” includes all of the following:
(a) Gestational diabetes.
(b) Insulin-dependent diabetes.
(c) Non-insulin-dependent diabetes.
History: Add. 2000, Act 425, Eff. Mar. 28, 2001
Popular Name: Act 218
Last modified: October 10, 2016