GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1997

H	1 

HOUSE BILL 5

Short Title:  Health Coverage/Diabetes.	(Public)

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Sponsors: Representatives Aldridge; Baddour, Boyd-McIntyre, Easterling, McAllister, Miller, Morris, Rayfield, Russell, Warner, and G. Wilson.

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Referred to:  Insurance.

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January 30, 1997

A BILL TO BE ENTITLED
AN ACT TO REQUIRE CERTAIN COVERAGE FOR DIABETES IN HEALTH AND ACCIDENT INSURANCE POLICIES, IN HOSPITAL OR MEDICAL SERVICES PLANS, AND IN HMO PLANS.
The General Assembly of North Carolina enacts:
Section 1.  Article 51 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-51-59A.  Coverage for certain treatment for diabetes.
(a)	Every policy or contract of accident or health insurance, and every preferred provider contract, policy, or plan as defined and regulated under G.S. 58-50-50 and G.S. 58-50-55, that is issued, renewed, or amended on or after October 1, 1997, shall provide coverage for medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient's treating physician or a physician who specializes in the treatment of diabetes certifies that such services are medically necessary. Diabetes outpatient self-management training and educational services must be provided under the direct supervision of a certified diabetes educator or a board-certified endocrinologist.  Nutrition counseling must be provided by a licensed dietician. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b)	The North Carolina Medical Care Commission shall adopt rules establishing standards for diabetes outpatient self-management training and educational services that have been accepted by the American Diabetes Association."
Section 2.  Article 65 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-65-94A. Coverage for certain treatment of diabetes.
(a)	Every insurance certificate or subscriber contract under any hospital service plan or medical service plan governed by this Article and Article 66 of this Chapter, and every preferred provider contract, policy, or plan as defined and regulated under G.S. 58-50-50 and G.S. 58-50-55, that is issued, renewed, or amended on or after October 1, 1997, shall provide coverage for medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient's treating physician or a physician who specializes in the treatment of diabetes certifies that such services are medically necessary. Diabetes outpatient self-management training and educational services must be provided under the direct supervision of a certified diabetes educator or a board-certified endocrinologist.  Nutrition counseling must be provided by a licensed dietician. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b)	The North Carolina Medical Care Commission shall adopt rules establishing standards for diabetes outpatient self-management training and educational services that have been accepted by the American Diabetes Association."
Section 3.  Article 67 of Chapter 58 of the General Statutes reads as rewritten:
"§ 58-67-78A.  Coverage for certain treatment of diabetes.
(a)	Every health care plan written by a health maintenance organization and in force, issued, renewed, or amended on or after October 1, 1997, that is subject to this Article, shall provide coverage for medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient's treating physician or a physician who specializes in the treatment of diabetes certifies that such services are medically necessary. Diabetes outpatient self-management training and educational services must be provided under the direct supervision of a certified diabetes educator or a board-certified endocrinologist.  Nutrition counseling must be provided by a licensed dietician. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b)	The North Carolina Medical Care Commission shall adopt rules establishing standards for diabetes outpatient self-management training and educational services that have been accepted by the American Diabetes Association."
Section 4.  Nothing in this act shall apply to specified accident, specified disease, hospital indemnity, or long-term care health insurance policies.
Section 5.  This act is effective when it becomes law.