Illinois General Assembly - Full Text of HB2249
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Full Text of HB2249  97th General Assembly


Rep. Michael W. Tryon

Filed: 3/31/2011





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2    AMENDMENT NO. ______. Amend House Bill 2249 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 356w as follows:
6    (215 ILCS 5/356w)
7    Sec. 356w. Diabetes self-management training and
9    (a) A group policy of accident and health insurance that is
10amended, delivered, issued, or renewed after the effective date
11of this amendatory Act of 1998 shall provide coverage for
12outpatient self-management training and education, equipment,
13and supplies, as set forth in this Section, for the treatment
14of type 1 diabetes, type 2 diabetes, and gestational diabetes
16    (b) As used in this Section:



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1    "Diabetes self-management training" means instruction in
2an outpatient setting which enables a diabetic patient to
3understand the diabetic management process and daily
4management of diabetic therapy as a means of avoiding frequent
5hospitalization and complications. Diabetes self-management
6training shall include the content areas listed in the National
7Standards for Diabetes Self-Management Education Programs as
8published by the American Diabetes Association, including
9medical nutrition therapy and education programs that allow the
10patient to maintain an A1c level within the range identified in
11nationally recognized standards of care.
12    "Medical nutrition therapy" shall have the meaning
13ascribed to "medical nutrition care" in the Dietetic and
14Nutrition Services Practice Act.
15    "Physician" means a physician licensed to practice
16medicine in all of its branches providing care to the
18    "Qualified provider" for an individual that is enrolled in:
19        (1) a health maintenance organization that uses a
20    primary care physician to control access to specialty care
21    means (A) the individual's primary care physician licensed
22    to practice medicine in all of its branches, (B) a
23    physician licensed to practice medicine in all of its
24    branches to whom the individual has been referred by the
25    primary care physician, or (C) a certified, registered, or
26    licensed network health care professional with expertise



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1    in diabetes management to whom the individual has been
2    referred by the primary care physician.
3        (2) an insurance plan means (A) a physician licensed to
4    practice medicine in all of its branches or (B) a
5    certified, registered, or licensed health care
6    professional with expertise in diabetes management to whom
7    the individual has been referred by a physician.
8    (c) Coverage under this Section for diabetes
9self-management training, including medical nutrition
10education, shall be limited to the following:
11        (1) Up to 3 medically necessary visits to a qualified
12    provider upon initial diagnosis of diabetes by the
13    patient's physician or, if diagnosis of diabetes was made
14    within one year prior to the effective date of this
15    amendatory Act of 1998 where the insured was a covered
16    individual, up to 3 medically necessary visits to a
17    qualified provider within one year after that effective
18    date.
19        (2) Up to 2 medically necessary visits to a qualified
20    provider upon a determination by a patient's physician that
21    a significant change in the patient's symptoms or medical
22    condition has occurred. A "significant change" in
23    condition means symptomatic hyperglycemia (greater than
24    250 mg/dl on repeated occasions), severe hypoglycemia
25    (requiring the assistance of another person), onset or
26    progression of diabetes, or a significant change in medical



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1    condition that would require a significantly different
2    treatment regimen.
3    Payment by the insurer or health maintenance organization
4for the coverage required for diabetes self-management
5training pursuant to the provisions of this Section is only
6required to be made for services provided. No coverage is
7required for additional visits beyond those specified in items
8(1) and (2) of this subsection.
9    Coverage under this subsection (c) for diabetes
10self-management training shall be subject to the same
11deductible, co-payment, and co-insurance provisions that apply
12to coverage under the policy for other services provided by the
13same type of provider.
14    (d) Coverage shall be provided for the following equipment
15when medically necessary and prescribed by a physician licensed
16to practice medicine in all of its branches. Coverage for the
17following items shall be subject to deductible, co-payment and
18co-insurance provisions provided for under the policy or a
19durable medical equipment rider to the policy:
20        (1) blood glucose monitors;
21        (2) blood glucose monitors for the legally blind;
22        (3) cartridges for the legally blind; and
23        (4) lancets and lancing devices.
24    This subsection does not apply to a group policy of
25accident and health insurance that does not provide a durable
26medical equipment benefit.



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1    (e) Coverage shall be provided for the following
2pharmaceuticals and supplies when medically necessary and
3prescribed by a physician licensed to practice medicine in all
4of its branches. Coverage for the following items shall be
5subject to the same coverage, deductible, co-payment, and
6co-insurance provisions under the policy or a drug rider to the
8        (1) insulin;
9        (2) syringes and needles;
10        (3) test strips for glucose monitors;
11        (4) FDA approved oral agents used to control blood
12    sugar; and
13        (5) glucagon emergency kits.
14    This subsection does not apply to a group policy of
15accident and health insurance that does not provide a drug
17    (f) Coverage shall be provided for regular foot care exams
18by a physician or by a physician to whom a physician has
19referred the patient. Coverage for regular foot care exams
20shall be subject to the same deductible, co-payment, and
21co-insurance provisions that apply under the policy for other
22services provided by the same type of provider.
23    (g) If authorized by a physician, diabetes self-management
24training may be provided as a part of an office visit, group
25setting, or home visit.
26    (h) This Section shall not apply to agreements, contracts,



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1or policies that provide coverage for a specified diagnosis or
2other limited benefit coverage.
3(Source: P.A. 90-741, eff. 1-1-99.)".