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

                                  3652

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 27, 2009
                               ___________

Introduced  by  M.  of  A.  O'DONNELL, PHEFFER, GOTTFRIED, BING, GREENE,
  GUNTHER, KELLNER, DINOWITZ -- Multi-Sponsored by -- M. of  A.  ALFANO,
  BARRA, BRENNAN, CLARK, COLTON, DIAZ, ERRIGO, GLICK, V. LOPEZ, SEMINER-
  IO, TITUS, WALKER -- read once and referred to the Committee on Insur-
  ance

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00043-01-9
              

A. 3652                             2

diabetes  are educated as to the proper self-management and treatment 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
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

A. 3652                             3

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 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.