SECTION 1. Section 27-18-38 of the General Laws in Chapter 27-18 entitled "Accident and Sickness Insurance Policies" is hereby amended to read as follows: 27-18-38. Diabetes treatment.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage, except for supplemental policies that only provide coverage for specified diseases and other supplemental policies, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation.
(b) Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates changes in a patient’s self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or, upon the physician’s referral to an appropriately licensed and certified healthcare provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.
(c) Benefit plans offered by an insurer may impose copayment and/or deductibles for the benefits mandated by this chapter; however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this section shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.
(d) Commencing January 1, 2027, coverage for equipment and supplies for insulin administration and glucose monitoring shall have a cap on the amount that a covered person is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. If the application of the cap to a specific item of equipment or supply before a covered person has met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
SECTION 2. Section 27-19-35 of the General Laws in Chapter 27-19 entitled "Nonprofit Hospital Service Corporations" is hereby amended to read as follows: 27-19-35. Diabetes treatment.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. The policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self- management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates changes in a patient’s self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or upon his or her referral by an appropriately licensed and certified healthcare provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.
(b) Benefit plans offered by a hospital service corporation may impose copayment or deductibles, or both, for the benefits mandated by this chapter, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.
(c) Commencing January 1, 2027, coverage for equipment and supplies for insulin administration and glucose monitoring shall have a cap on the amount that a covered person is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. If the application of the cap to a specific item of equipment or supply before a covered person has met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
SECTION 3. Section 27-20-30 of the General Laws in Chapter 27-20 entitled "Nonprofit Medical Service Corporations" is hereby amended to read as follows: 27-20-30. Diabetes treatment.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind; test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps, and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates changes in a patient’s self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral, to an appropriately licensed and certified healthcare provider, and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.
(b) Benefit plans offered by a medical service corporation may impose copayment or deductibles or both for the benefits mandated by this chapter, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.
(c) Commencing January 1, 2027, coverage for equipment and supplies for insulin administration and glucose monitoring shall have a cap on the amount that a covered person is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. If the application of the cap to a specific item of equipment or supply before a covered person has met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
SECTION 4. Section 27-41-44 of the General Laws in Chapter 27-41 entitled "Health Maintenance Organizations" is hereby amended to read as follows: 27-41-44. Diabetes treatment.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides medical coverage that includes coverage for physician services in a physician’s office and every policy that provides major medical or similar comprehensive-type coverage shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to them, insulin infusion devices, oral agents for controlling blood sugar, and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of this new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self- management and treatment of their diabetes, including information on the nutritional management of diabetes. This coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patient’s symptoms or conditions that necessitates changes in a patient’s self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral to an appropriately licensed and certified healthcare provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.
(b) Benefit plans offered by a health maintenance organization may impose copayment or deductibles, or both, for the benefits mandated by this chapter. However, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.
(c) Commencing January 1, 2027, coverage for equipment and supplies for insulin administration and glucose monitoring shall have a cap on the amount that a covered person is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty
(30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. If the application of the cap to a specific item of equipment or supply before a covered person has met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
SECTION 5. Chapter 36-12 of the General Laws entitled "Insurance Benefits" is hereby amended by adding thereto the following section: 36-12-2.6. Health insurance benefits - Diabetes treatment. Commencing on and after January 1, 2027, when the health insurance plan for employees of the State of Rhode Island is purchased or renewed by the director of administration pursuant to § 36-12-6, the plan shall provide for the coverage of equipment and supplies for insulin administration and glucose monitoring, and shall have a cap on the amount that a covered person is required to pay for such equipment and supplies at no more than twenty-five dollars ($25.00) per a supply lasting thirty (30) days, or per item when an item is intended to be used for longer than thirty (30) days. Coverage for such equipment and supplies shall not be subject to any annual deductible. If the application of the cap to a specific item of equipment or supply before a covered person has met their plan's deductible would result in health savings account ineligibility under 26 U.S.C. § 223, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
SECTION 6. This act shall take effect on January 1, 2027.
