AN
ACT Relating to the enactment of the diabetes cost reduction act; adding a new
section to chapter 41.05 RCW; adding a new section to chapter 48.20 RCW; adding
a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW;
adding a new section to chapter 48.46 RCW; adding new sections to chapter
43.131 RCW; and providing an effective date.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. A
new section is added to chapter 41.05 RCW to read as follows:
The
legislature finds that diabetes imposes a significant health risk and
tremendous financial burden on the citizens and government of the state of
Washington, and that access to the medically accepted standards of care for
diabetes, its treatment and supplies, and self-management training and
education is crucial to prevent or delay the short and long-term complications of
diabetes and its attendant costs.
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Person with diabetes" means a person diagnosed by a health care
provider as having insulin using diabetes, noninsulin using diabetes, or
elevated blood glucose levels induced by pregnancy; and
(b)
"Health care provider" means a health care provider as defined in RCW
48.43.005.
(2)
All state-purchased health care purchased or renewed after the effective date
of this act, except the basic health plan described in chapter 70.47 RCW, shall
provide benefits for at least the following services and supplies for persons
with diabetes:
(a)
For state-purchased health care that includes coverage for pharmacy services,
appropriate and medically necessary equipment and supplies, as prescribed by a
health care provider, that includes but is not limited to insulin, syringes,
injection aids, blood glucose monitors, test strips for blood glucose monitors,
visual reading and urine test strips, insulin pumps and accessories to the
pumps, insulin infusion devices, prescriptive oral agents for controlling blood
sugar levels, foot care appliances for prevention of complications associated
with diabetes, and glucagon emergency kits; and
(b)
For all state-purchased health care, outpatient self-management training and
education, including medical nutrition therapy, as ordered by the health care
provider. Diabetes outpatient self-management training and education may be
provided only by health care providers with expertise in diabetes. Nothing in
this section prevents any state agency purchasing health care according to this
section from restricting patients to seeing only health care providers who have
signed participating provider agreements with that state agency or an insuring
entity under contract with that state agency.
(3)
Coverage required under this section may be subject to customary cost-sharing
provisions established for all other similar services or supplies within a
policy.
(4)
Health care coverage may not be reduced or eliminated due to this section.
(5)
Services required under this section shall be covered when deemed medically
necessary by the medical director, or his or her designee, subject to any
referral and formulary requirements.
NEW
SECTION. Sec. 2. A
new section is added to chapter 48.20 RCW to read as follows:
The
legislature finds that diabetes imposes a significant health risk and
tremendous financial burden on the citizens and government of the state of
Washington, and that access to the medically accepted standards of care for
diabetes, its treatment and supplies, and self-management training and
education is crucial to prevent or delay the short and long-term complications
of diabetes and its attendant costs.
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Person with diabetes" means a person diagnosed by a health care
provider as having insulin using diabetes, noninsulin using diabetes, or
elevated blood glucose levels induced by pregnancy; and
(b)
"Health care provider" means a health care provider as defined in RCW
48.43.005.
(2)
All disability insurance contracts providing health care services, delivered or
issued for delivery in this state and issued or renewed after the effective
date of this act, shall provide benefits for at least the following services
and supplies for persons with diabetes:
(a)
For disability insurance contracts that include pharmacy services, appropriate
and medically necessary equipment and supplies, as prescribed by a health care
provider, that includes but is not limited to insulin, syringes, injection
aids, blood glucose monitors, test strips for blood glucose monitors, visual
reading and urine test strips, insulin pumps and accessories to the pumps,
insulin infusion devices, prescriptive oral agents for controlling blood sugar
levels, foot care appliances for prevention of complications associated with
diabetes, and glucagon emergency kits; and
(b)
For all disability insurance contracts providing health care services,
outpatient self-management training and education, including medical nutrition
therapy, as ordered by the health care provider. Diabetes outpatient
self-management training and education may be provided only by health care
providers with expertise in diabetes. Nothing in this section prevents the
insurer from restricting patients to seeing only health care providers who have
signed participating provider agreements with the insurer or an insuring entity
under contract with the insurer.
(3)
Coverage required under this section may be subject to customary cost-sharing
provisions established for all other similar services or supplies within a
policy.
(4)
Health care coverage may not be reduced or eliminated due to this section.
(5)
Services required under this section shall be covered when deemed medically necessary
by the medical director, or his or her designee, subject to any referral and
formulary requirements.
(6)
The insurer need not include the coverage required in this section in a group
contract offered to an employer or other group that offers to its eligible
enrollees a self-insured health plan not subject to mandated benefits status
under this title that does not offer coverage similar to that mandated under
this section.
(7)
This section does not apply to the health benefit plan that provides benefits
identical to the schedule of services covered by the basic health plan, as
required by RCW 48.20.028.
NEW
SECTION. Sec. 3. A
new section is added to chapter 48.21 RCW to read as follows:
The
legislature finds that diabetes imposes a significant health risk and
tremendous financial burden on the citizens and government of the state of
Washington, and that access to the medically accepted standards of care for
diabetes, its treatment and supplies, and self-management training and
education is crucial to prevent or delay the short and long-term complications
of diabetes and its attendant costs.
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Person with diabetes" means a person diagnosed by a health care
provider as having insulin using diabetes, noninsulin using diabetes, or
elevated blood glucose levels induced by pregnancy; and
(b)
"Health care provider" means a health care provider as defined in RCW
48.43.005.
(2)
All group disability insurance contracts and blanket disability insurance
contracts providing health care services, issued or renewed after the effective
date of this act, shall provide benefits for at least the following services
and supplies for persons with diabetes:
(a)
For group disability insurance contracts and blanket disability
insurance
contracts that include coverage for pharmacy services, appropriate and
medically necessary equipment and supplies, as prescribed by a health care
provider, that includes but is not limited to insulin, syringes, injection
aids, blood glucose monitors, test strips for blood glucose monitors, visual
reading and urine test strips, insulin pumps and accessories to the pumps,
insulin infusion devices, prescriptive oral agents for controlling blood sugar
levels, foot care appliances for prevention of complications associated with
diabetes, and glucagon emergency kits; and
(b)
For all group disability insurance contracts and blanket disability insurance
contracts providing health care services, outpatient self-management training
and education, including medical nutrition therapy, as ordered by the health
care provider. Diabetes outpatient self-management training and education may
be provided only by health care providers with expertise in diabetes. Nothing
in this section prevents the insurer from restricting patients to seeing only
health care providers who have signed participating provider agreements with
the insurer or an insuring entity under contract with the insurer.
(3)
Coverage required under this section may be subject to customary cost-sharing
provisions established for all other similar services or supplies within a
policy.
(4)
Health care coverage may not be reduced or eliminated due to this section.
(5)
Services required under this section shall be covered when deemed medically
necessary by the medical director, or his or her designee, subject to any
referral and formulary requirements.
(6)
The insurer need not include the coverage required in this section in a group
contract offered to an employer or other group that offers to its eligible
enrollees a self-insured health plan not subject to mandated benefits status
under this title that does not offer coverage similar to that mandated under
this section.
(7)
This section does not apply to the health benefit plan that provides benefits
identical to the schedule of services covered by the basic health plan, as
required by RCW 48.21.045.
NEW
SECTION. Sec. 4. A
new section is added to chapter 48.44 RCW to read as follows:
The
legislature finds that diabetes imposes a significant health risk and
tremendous financial burden on the citizens and government of the state of
Washington, and that access to the medically accepted standards of care for
diabetes, its treatment and supplies, and self-management training and
education is crucial to prevent or delay the short and long-term complications
of diabetes and its attendant costs.
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Person with diabetes" means a person diagnosed by a health care
provider as having insulin using diabetes, noninsulin using diabetes, or
elevated blood glucose levels induced by pregnancy; and
(b)
"Health care provider" means a health care provider as defined in RCW
48.43.005.
(2)
All health benefit plans offered by health care service contractors, issued or
renewed after the effective date of this act, shall provide benefits for at
least the following services and supplies for persons with diabetes:
(a)
For health benefit plans that include coverage for pharmacy services,
appropriate and medically necessary equipment and supplies, as prescribed by a
health care provider, that includes but is not limited to insulin, syringes,
injection aids, blood glucose monitors, test strips for blood glucose monitors,
visual reading and urine test strips, insulin pumps and accessories to the
pumps, insulin infusion devices, prescriptive oral agents for controlling blood
sugar levels, foot care appliances for prevention of complications associated
with diabetes, and glucagon emergency kits; and
(b)
For all health benefit plans, outpatient self-management training and
education, including medical nutrition therapy, as ordered by the health care
provider. Diabetes outpatient self-management training and education may be
provided only by health care providers with expertise in diabetes. Nothing in
this section prevents the health care services contractor from restricting
patients to seeing only health care providers who have signed participating
provider agreements with the health care services contractor or an insuring
entity under contract with the health care services contractor.
(3)
Coverage required under this section may be subject to customary cost-sharing
provisions established for all other similar services or supplies within a
policy.
(4)
Health care coverage may not be reduced or eliminated due to this section.
(5)
Services required under this section shall be covered when deemed medically
necessary by the medical director, or his or her designee, subject to any
referral and formulary requirements.
(6)
The health care service contractor need not include the coverage required in
this section in a group contract offered to an employer or other group that
offers to its eligible enrollees a self-insured health plan not subject to
mandated benefits status under this title that does not offer coverage similar
to that mandated under this section.
(7)
This section does not apply to the health benefit plans that provide benefits
identical to the schedule of services covered by the basic health plan, as
required by RCW 48.44.022 and 48.44.023.
NEW
SECTION. Sec. 5. A
new section is added to chapter 48.46 RCW to read as follows:
The
legislature finds that diabetes imposes a significant health risk and
tremendous financial burden on the citizens and government of the state of
Washington, and that access to the medically accepted standards of care for
diabetes, its treatment and supplies, and self-management training and
education is crucial to prevent or delay the short and long-term complications
of diabetes and its attendant costs.
(1)
The definitions in this subsection apply throughout this section unless the
context clearly requires otherwise.
(a)
"Person with diabetes" means a person diagnosed by a health care
provider as having insulin using diabetes, noninsulin using diabetes, or
elevated blood glucose levels induced by pregnancy; and
(b)
"Health care provider" means a health care provider as defined in RCW
48.43.005.
(2)
All health benefit plans offered by health maintenance organizations, issued or
renewed after the effective date of this act, shall provide benefits for at
least the following services and supplies for persons with diabetes:
(a)
For health benefit plans that include coverage for pharmacy services,
appropriate and medically necessary equipment and supplies, as prescribed by a
health care provider, that includes but is not limited to insulin, syringes,
injection aids, blood glucose monitors, test strips for blood glucose monitors,
visual reading and urine test strips, insulin pumps and accessories to the
pumps, insulin infusion devices, prescriptive oral agents for controlling blood
sugar levels, foot care appliances for prevention of complications associated
with diabetes, and glucagon emergency kits; and
(b)
For all health benefit plans, outpatient self-management training and education,
including medical nutrition therapy, as ordered by the health care provider.
Diabetes outpatient self-management training and education may be provided only
by health care providers with expertise in diabetes. Nothing in this section
prevents the health maintenance organization from restricting patients to
seeing only health care providers who have signed participating provider
agreements with the health maintenance organization or an insuring entity under
contract with the health maintenance organization.
(3)
Coverage required under this section may be subject to customary cost-sharing
provisions established for all other similar services or supplies within a
policy.
(4)
Health care coverage may not be reduced or eliminated due to this section.
(5)
Services required under this section shall be covered when deemed medically
necessary by the medical director, or his or her designee, subject to any
referral and formulary requirements.
(6)
The health maintenance organization need not include the coverage required in
this section in a group contract offered to an employer or other group that
offers to its eligible enrollees a self-insured health plan not subject to
mandated benefits status under this title that does not offer coverage similar
to that mandated under this section.
(7)
This section does not apply to the health benefit plans that provide benefits
identical to the schedule of services covered by the basic health plan, as
required by RCW 48.46.064 and 48.46.066.
NEW
SECTION. Sec. 6. This
act takes effect January 1, 1998.
NEW
SECTION. Sec. 7. A
new section is added to chapter 43.131 RCW to read as follows:
The
diabetes cost reduction act shall be terminated on June 30, 2001.
NEW
SECTION. Sec. 8. A
new section is added to chapter 43.131 RCW to read as follows:
The
following acts or parts of acts, as now existing or hereafter amended, are each
repealed, effective June 30, 2002:
(1)
RCW 41.05.--- and 1997 c . . . s 1 (section 1 of this act);
(2)
RCW 48.20.--- and 1997 c . . . s 2 (section 2 of this act);
(3)
RCW 48.21.--- and 1997 c . . . s 3 (section 3 of this act);
(4)
RCW 48.44.--- and 1997 c . . . s 4 (section 4 of this act); and
(5)
RCW 48.46.--- and 1997 c . . . s 5 (section 5 of this act).
