Bill Text: VA HB645 | 2020 | Regular Session | Prefiled
Bill Title: Health insurance; coverage for diabetes.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2020-02-11 - Left in Labor and Commerce [HB645 Detail]
Download: Virginia-2020-HB645-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §38.2-3418.10 of the Code of Virginia is amended and reenacted as follows:
§38.2-3418.10. Coverage for diabetes.
A. Each insurer proposing to issue an individual or group
hospital policy or major medical policy in this the Commonwealth, each
corporation proposing to issue an individual or group hospital, medical or
major medical subscription contract, and each health maintenance organization
providing a health care plan for health care services shall provide coverage
for diabetes as provided in this section.
B. Such coverage shall include benefits for (i) FDA-approved insulin,
if prescribed by a licensed practitioner and such
policy, plan, or contract includes a prescription drug benefit; (ii)
equipment, including blood
glucose monitors, accessible blood glucose monitors for individuals who are
legally blind, cartridges for the legally blind,
and lancets and lancing devices;
(iii)
supplies, including
syringes and needles, FDA-approved
agents used to control blood sugar, and glucagon emergency kits;
(iv) continuous blood glucose monitoring for individuals
who are using insulin;
(v) regular foot care and eye care exams
provided by a certified, registered,
or licensed health care professional; and in-person outpatient (vi) self-management training
and education, either in-person
outpatient or through telemedicine, including medical
nutrition therapy, for the treatment of insulin-dependent diabetes,
insulin-using diabetes, gestational diabetes and noninsulin-using diabetes if
prescribed by a health care professional legally authorized to prescribe such
items under law. As used herein, the terms "equipment" and
"supplies" shall not be considered durable medical equipment.
C. Such coverage for self-management training and education, including medical nutrition therapy, shall include (i) up to three outpatient visits upon an individual receiving an initial diagnosis of diabetes, or if the individual was diagnosed in the year immediately preceding January 1, 2021, then up to three medically necessary visits to a qualified provider before January 1, 2022, and (ii) up to two medically necessary visits to a qualified provider upon a determination that a significant change in the patient's symptoms or medical condition has occurred. A "significant change in condition" means symptomatic hyperglycemia, greater than 250 mg/dl on repeated occasions, severe hypoglycemia requiring the assistance of another person, onset or progression of diabetes, or a significant change in medical condition that would require a significantly different treatment regimen.
D.
To qualify for coverage under this section, diabetes in-person outpatient
self-management training and education shall be provided by a certified,
registered,
or licensed health care professional. A managed care health insurance plan, as
defined in Chapter 58 (§38.2-5800 et seq.) of
this title, may require such health care professional to be
a member of the plan's provider network;, provided that such network
includes sufficient health care professionals who are qualified by specific
education, experience, and credentials to provide the covered benefits
described in this section.
D. E. No insurer, corporation, or
health maintenance organization shall impose upon any person receiving benefits
pursuant to this section any copayment, fee,
or condition that is not equally imposed upon all individuals in the same
benefit category, nor shall any insurer, corporation,
or health maintenance organization impose any policy-year or calendar-year
dollar or durational benefit limitations or maximums for benefits or services
provided under this section.
F. Benefits or services provided under this section shall be exempt from any deductible. Such exemption shall be expressly stated on the policy, contract, or plan providing such coverage.
E. G. The requirements of this
section shall apply to all insurance policies, contracts and plans delivered,
issued for delivery, reissued, or extended on and after July 1, 2000, or at any
time thereafter when any term of the policy, contract or plan is changed or any
premium adjustment is made.
F. H. This section shall not apply
to short-term travel, accident only, or limited or specified disease policies
or contracts, nor to policies or contracts designed for issuance to persons
eligible for coverage under Title XVIII of the Social Security Act, known as
Medicare, or any other similar coverage under state or federal governmental
plans.
2. That notwithstanding the provisions of subsection G of § 38.2-3418.10 of the Code of Virginia, as amended by this act, the provisions of this act shall apply to any insurance policy, contract, or plan delivered, issued for delivery, reissued, or extended on and after January 1, 2021, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.