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


Sen. William R. Haine

Filed: 5/13/2011





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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, as defined by
10the contract of insurance, that allow the patient to maintain
11an A1c level within the range identified in nationally
12recognized standards of care.
13    "Medical nutrition therapy" shall have the meaning
14ascribed to "medical nutrition care" in the Dietetic and
15Nutrition Services Practice Act.
16    "Physician" means a physician licensed to practice
17medicine in all of its branches providing care to the
19    "Qualified provider" for an individual that is enrolled in:
20        (1) a health maintenance organization that uses a
21    primary care physician to control access to specialty care
22    means (A) the individual's primary care physician licensed
23    to practice medicine in all of its branches, (B) a
24    physician licensed to practice medicine in all of its
25    branches to whom the individual has been referred by the
26    primary care physician, or (C) a certified, registered, or



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



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



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1medical equipment benefit.
2    (e) Coverage shall be provided for the following
3pharmaceuticals and supplies when medically necessary and
4prescribed by a physician licensed to practice medicine in all
5of its branches. Coverage for the following items shall be
6subject to the same coverage, deductible, co-payment, and
7co-insurance provisions under the policy or a drug rider to the
9        (1) insulin;
10        (2) syringes and needles;
11        (3) test strips for glucose monitors;
12        (4) FDA approved oral agents used to control blood
13    sugar; and
14        (5) glucagon emergency kits.
15    This subsection does not apply to a group policy of
16accident and health insurance that does not provide a drug
18    (f) Coverage shall be provided for regular foot care exams
19by a physician or by a physician to whom a physician has
20referred the patient. Coverage for regular foot care exams
21shall be subject to the same deductible, co-payment, and
22co-insurance provisions that apply under the policy for other
23services provided by the same type of provider.
24    (g) If authorized by a physician, diabetes self-management
25training may be provided as a part of an office visit, group
26setting, or home visit.



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1    (h) This Section shall not apply to agreements, contracts,
2or policies that provide coverage for a specified diagnosis or
3other limited benefit coverage.
4(Source: P.A. 90-741, eff. 1-1-99.)".