S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  3562

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2013
                               ___________

Introduced  by M. of A. O'DONNELL, GOTTFRIED, GUNTHER, KELLNER, DINOWITZ
  -- Multi-Sponsored by -- M. of A. BRENNAN, CLARK, COLTON, GLICK, TITUS
  -- read once and referred to the Committee on Insurance

AN ACT to amend the insurance law, in relation to medical  coverage  for
  certain diagnostic tests for diabetes

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subparagraph (A) of paragraph 15-a  of  subsection  (i)  of
section 3216 of the insurance law, as amended by chapter 338 of the laws
of 2003, is amended to read as follows:
  (A)  Every policy which provides medical coverage that includes cover-
age for physician services in a  physician's  office  and  every  policy
which  provides  major  medical  or  similar comprehensive-type coverage
shall include coverage for the following equipment [and],  supplies  AND
TESTS for the treatment, DIAGNOSIS AND PREVENTION of diabetes, if recom-
mended  or  prescribed  by  a  physician  or  other licensed health care
provider legally authorized to prescribe under title eight of the educa-
tion law: blood glucose monitors and  blood  glucose  monitors  for  the
visually  impaired,  data  management  systems,  test strips for glucose
monitors and visual reading and urine testing strips, insulin, injection
aids, cartridges for the visually impaired, syringes, insulin pumps  and
appurtenances  thereto,  insulin infusion devices, [and] oral agents for
controlling blood sugar AND GLYCATED HEMOGLOBIN (ALSO KNOW AS A1C) TESTS
UP TO FOUR TIMES PER YEAR.  In addition, the commissioner of the depart-
ment of health shall provide and periodically update by  rule  or  regu-
lation a list of additional diabetes equipment and related supplies such
as  are  medically  necessary  for  the treatment of diabetes, for which
there shall also be coverage. Such policies shall also include  coverage
for  diabetes  self-management  education  to  ensure  that persons with
diabetes are educated as to the proper self-management and treatment  of
their  diabetic  condition,  including information on proper diets. Such

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01579-01-3
              

A. 3562                             2

coverage for self-management education and education  relating  to  diet
shall  be  limited  to  visits medically necessary upon the diagnosis of
diabetes, where a  physician  diagnoses  a  significant  change  in  the
patient's   symptoms  or  conditions  which  necessitate  changes  in  a
patient's self-management, or where reeducation or  refresher  education
is  necessary.  Such education may be provided by the physician or other
licensed health care provider  legally  authorized  to  prescribe  under
title  eight  of the education law, or their staff, as part of an office
visit for diabetes diagnosis or treatment, or by  a  certified  diabetes
nurse  educator,  certified  nutritionist, certified dietitian or regis-
tered dietitian upon the referral  of  a  physician  or  other  licensed
health  care  provider legally authorized to prescribe under title eight
of the education law. Education provided by the certified diabetes nurse
educator, certified  nutritionist,  certified  dietitian  or  registered
dietitian may be limited to group settings wherever practicable.  Cover-
age  for  self-management education and education relating to diet shall
also include home visits when medically necessary.
  S 2. Subparagraph (A) of paragraph 7 of subsection (k) of section 3221
of the insurance law, as amended by chapter 338 of the laws of 2003,  is
amended to read as follows:
  (A) Every group or blanket accident and health insurance policy issued
or  issued  for  delivery  in this state which provides medical coverage
that includes coverage for physician services in  a  physician's  office
and  every policy which provides major medical or similar comprehensive-
type coverage shall include coverage for the following equipment  [and],
supplies  AND  TESTS  for  the  treatment,  DIAGNOSIS  OR  PREVENTION of
diabetes, if recommended or prescribed by a physician or other  licensed
health  care  provider legally authorized to prescribe under title eight
of the education law: blood glucose monitors and blood glucose  monitors
for  the  visually  impaired,  data  management systems, test strips for
glucose monitors and visual reading and urine testing  strips,  insulin,
injection  aids, cartridges for the visually impaired, syringes, insulin
pumps and appurtenances thereto, insulin infusion  devices,  [and]  oral
agents  for controlling blood sugar  AND GLYCATED HEMOGLOBIN (ALSO KNOWN
AS A1C) TESTS UP TO FOUR TIMES PER YEAR.  In addition, the  commissioner
of  the  department  of  health shall provide and periodically update by
rule or regulation a list of additional diabetes equipment  and  related
supplies  such as are medically necessary for the treatment of diabetes,
for which there shall also be coverage. Such policies shall also include
coverage for diabetes self-management education to ensure  that  persons
with  diabetes  are educated as to the proper self-management and treat-
ment of their diabetic condition, including information on proper diets.
Such coverage for self-management education and  education  relating  to
diet  shall  be limited to visits medically necessary upon the diagnosis
of diabetes, where a physician diagnoses a  significant  change  in  the
patient's   symptoms  or  conditions  which  necessitate  changes  in  a
patient's self-management, or where reeducation or  refresher  education
is  necessary.  Such education may be provided by the physician or other
licensed health care provider  legally  authorized  to  prescribe  under
title  eight  of the education law, or their staff, as part of an office
visit for diabetes diagnosis or treatment, or by  a  certified  diabetes
nurse  educator,  certified  nutritionist, certified dietitian or regis-
tered dietitian upon the referral  of  a  physician  or  other  licensed
health  care  provider legally authorized to prescribe under title eight
of the education law. Education provided by the certified diabetes nurse
educator, certified  nutritionist,  certified  dietitian  or  registered

A. 3562                             3

dietitian may be limited to group settings wherever practicable.  Cover-
age  for  self-management education and education relating to diet shall
also include home visits when medically necessary.
  S  3.  Paragraph  1 of subsection (u) of section 4303 of the insurance
law, as amended by chapter 338 of the laws of 2003, is amended  to  read
as follows:
  (1) A medical expense indemnity corporation or a health service corpo-
ration which provides medical coverage that includes coverage for physi-
cian  services  in  a physician's office and every policy which provides
major medical  or  similar  comprehensive-type  coverage  shall  include
coverage  for  the following equipment [and], supplies AND TESTS for the
treatment, DIAGNOSIS AND  PREVENTION  of  diabetes,  if  recommended  or
prescribed by a physician or other licensed health care provider legally
authorized  to  prescribe  under title eight of the education law: blood
glucose monitors and blood glucose monitors for the  visually  impaired,
data  management  systems,  test  strips for glucose monitors and visual
reading and urine testing strips, insulin,  injection  aids,  cartridges
for  the  visually  impaired,  syringes, insulin pumps and appurtenances
thereto, insulin infusion devices, [and]  oral  agents  for  controlling
blood sugar AND GLYCATED HEMOGLOBIN (ALSO KNOWN AS A1C) TESTS UP TO FOUR
TIMES  PER  YEAR.  In  addition,  the  commissioner of the department of
health shall provide and periodically update by  rule  or  regulation  a
list  of  additional diabetes equipment and related supplies such as are
medically necessary for the treatment of diabetes, for which there shall
also be coverage. Such policies shall also include coverage for diabetes
self-management education to  ensure  that  persons  with  diabetes  are
educated as to the proper self-management and treatment of their diabet-
ic  condition,  including information on proper diets. Such coverage for
self-management education and education relating to diet shall be limit-
ed to visits medically necessary upon the diagnosis of diabetes, where a
physician diagnoses a significant change in the  patient's  symptoms  or
conditions  which necessitate changes in a patient's self-management, or
where reeducation or refresher education is  necessary.  Such  education
may  be provided by the physician or other licensed health care provider
legally authorized to prescribe under title eight of the education  law,
or  their  staff,  as  part of an office visit for diabetes diagnosis or
treatment, or by a certified diabetes nurse educator,  certified  nutri-
tionist,  certified  dietitian or registered dietitian upon the referral
of a physician or other licensed health care provider legally authorized
to prescribe under title eight of the education law. Education  provided
by the certified diabetes nurse educator, certified nutritionist, certi-
fied  dietitian or registered dietitian may be limited to group settings
wherever practicable.  Coverage for self-management education and educa-
tion relating to diet shall also  include  home  visits  when  medically
necessary.
  S 4. This act shall take effect immediately and apply to all contracts
or  renewal  contracts  entered  into  on  and  after January first next
succeeding the date on which it shall have become a law.