S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8292
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               June 13, 2019
                                ___________
 
 Introduced  by M. of A. SIMOTAS -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law, in relation to  limiting  co-payments
   for insulin
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph 15-a of subsection (i) of  section  3216  of  the
 insurance  law, as added by chapter 378 of the laws of 1993 such section
 as renumbered and subparagraph (A) as amended by chapter 338 of the laws
 of 2003, is amended to read as follows:
   (15-a) (A) Every policy 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 for  the
 treatment  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. 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  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13090-02-9

 A. 8292                             2
 
 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.
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with those  established  for  other  benefits  within  a  given  policy;
 PROVIDED, HOWEVER, THAT A COVERED PERSON SHALL NOT BE REQUIRED TO PAY AN
 AMOUNT  IN  EXCESS  OF  ONE  HUNDRED  DOLLARS  PER  THIRTY DAY SUPPLY OF
 PRESCRIPTION INSULIN REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN  NEEDED
 TO FILL THE COVERED PERSON'S PRESCRIPTION, HOWEVER NOTHING SHALL PREVENT
 AN INSURER FROM REDUCING SUCH MAXIMUM AMOUNT.
   §  2.  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:
   (7)(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  compre-
 hensive-type coverage shall include coverage for the following equipment
 and supplies for the treatment 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 moni-
 tors  and blood glucose monitors for the visually impaired, data manage-
 ment systems, test strips for glucose monitors and  visual  reading  and
 urine  testing strips, insulin, injection aids, cartridges for the visu-
 ally impaired, syringes, insulin pumps and appurtenances thereto,  insu-
 lin  infusion  devices,  and oral agents for controlling blood sugar. 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 educa-
 tion  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 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 neces-
 sitate 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

 A. 8292                             3
 
 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 certi-
 fied  diabetes  nurse educator, certified nutritionist, certified dieti-
 tian or registered dietitian may be limited to group  settings  wherever
 practicable.    Coverage  for  self-management  education  and education
 relating to diet shall also include home visits  when  medically  neces-
 sary.
   (B) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with  those  established  for  other  benefits  within  a  given policy;
 PROVIDED, HOWEVER, THAT A COVERED PERSON SHALL NOT BE REQUIRED TO PAY AN
 AMOUNT IN EXCESS OF  ONE  HUNDRED  DOLLARS  PER  THIRTY  DAY  SUPPLY  OF
 PRESCRIPTION  INSULIN REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED
 TO FILL THE COVERED PERSON'S PRESCRIPTION, HOWEVER NOTHING SHALL PREVENT
 AN INSURER FROM REDUCING SUCH MAXIMUM AMOUNT.
   (C) This paragraph shall not apply to a policy  which  covers  persons
 employed  in  more  than one state or the benefit structure of which was
 the subject of collective bargaining affecting persons employed in  more
 than  one  state  unless  such policy is issued under the New York state
 health insurance plan established under  article  eleven  of  the  civil
 service law or issued to or through a local government.
   §  3.  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:
   (u) (1) A medical expense indemnity corporation or  a  health  service
 corporation  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 for the treat-
 ment 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. 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  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. 8292                             4

 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.
   (2) Such coverage may be subject to annual deductibles and coinsurance
 as may be deemed appropriate by the superintendent and as are consistent
 with those  established  for  other  benefits  within  a  given  policy;
 PROVIDED, HOWEVER, THAT A COVERED PERSON SHALL NOT BE REQUIRED TO PAY AN
 AMOUNT  IN  EXCESS  OF  ONE  HUNDRED  DOLLARS  PER  THIRTY DAY SUPPLY OF
 PRESCRIPTION INSULIN REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN  NEEDED
 TO FILL THE COVERED PERSON'S PRESCRIPTION, HOWEVER NOTHING SHALL PREVENT
 AN INSURER FROM REDUCING SUCH MAXIMUM AMOUNT.
   (3)  This  subsection shall not apply to a policy which covers persons
 employed in more than one state or the benefit structure  of  which  was
 the  subject of collective bargaining affecting persons employed in more
 than one state unless such policy is issued under  the  New  York  state
 health  insurance  plan  established  under  article eleven of the civil
 service law or issued to or through a local government.
   § 4. This act shall take effect January 1, 2020 and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.