S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6923
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to  amend  the  insurance  law, in relation to requiring health
   insurance plans to provide coverage for continuous blood glucose moni-
   tors for all children
 
   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 for the
 treatment of diabetes AND  OTHER  SUGAR  DISORDERS,  if  recommended  or
 prescribed by a physician or other licensed health care provider legally
 authorized  to prescribe under title eight of the education law, REGARD-
 LESS OF THE PATIENT'S AGE:   blood glucose monitors  and  blood  glucose
 monitors  for  the visually impaired, CONTINUOUS BLOOD GLUCOSE MONITORS,
 INCLUDING BUT NOT LIMITED TO DEVICES PRODUCED BY DEXCOM, 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 addi-
 tion, 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10846-01-5
              

 A. 6923                             2
 
 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
 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.
   § 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  for  the  treatment  of diabetes AND OTHER SUGAR DISORDERS, if
 recommended or prescribed by a physician or other licensed  health  care
 provider legally authorized to prescribe under title eight of the educa-
 tion  law,  REGARDLESS  OF THE PATIENT'S AGE: blood glucose monitors and
 blood glucose monitors  for  the  visually  impaired,  CONTINUOUS  BLOOD
 GLUCOSE  MONITORS,  INCLUDING  BUT  NOT  LIMITED  TO DEVICES PRODUCED BY
 DEXCOM, 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 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
 A. 6923                             3
 
 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.
   § 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 for the  treatment  of
 diabetes  AND  OTHER  SUGAR DISORDERS, if recommended or prescribed by a
 physician or other licensed health care provider legally  authorized  to
 prescribe  under  title  eight  of  the education law, REGARDLESS OF THE
 PATIENT'S AGE:  blood glucose monitors and blood  glucose  monitors  for
 the  visually impaired, CONTINUOUS BLOOD GLUCOSE MONITORS, INCLUDING BUT
 NOT LIMITED TO DEVICES PRODUCED BY DEXCOM, 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  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
 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.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law, and shall apply to  policies  and  contracts  issued,
 renewed, amended, modified or altered on or after such date.