HOUSE BILL No. 4359
February 19, 1997, Introduced by Reps. Hammerstrom, Martinez, DeHart, Scott, Mans and Goschka and referred to the Committee on Insurance.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
(MCL 550.1101 to 550.1704) by adding section 416b.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 SEC. 416B. (1) A HEALTH CARE CORPORATION CERTIFICATE SHALL
2 PROVIDE BENEFITS IN EACH GROUP AND NONGROUP CERTIFICATE FOR THE
3 FOLLOWING EQUIPMENT, SUPPLIES, AND EDUCATIONAL TRAINING FOR THE
4 TREATMENT OF DIABETES, IF RECOMMENDED OR PRESCRIBED BY A
5 PHYSICIAN:
6 (A) BLOOD GLUCOSE MONITORS AND BLOOD GLUCOSE MONITORS FOR
7 THE LEGALLY BLIND.
8 (B) DATA MANAGEMENT SYSTEMS.
9 (C) TEST STRIPS FOR GLUCOSE MONITORS AND VISUAL READING AND
10 URINE TESTING STRIPS.
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1 (D) INSULIN.
2 (E) INJECTION AIDS.
3 (F) CARTRIDGES FOR THE LEGALLY BLIND.
4 (G) SYRINGES.
5 (H) INSULIN PUMPS AND APPURTENANCES THERETO.
6 (I) INSULIN INFUSION DEVICES.
7 (J) ORAL AGENTS FOR CONTROLLING BLOOD SUGAR.
8 (K) DIABETES SELF-MANAGEMENT TRAINING TO ENSURE THAT PERSONS
9 WITH DIABETES ARE TRAINED AS TO THE PROPER SELF-MANAGEMENT AND
10 TREATMENT OF THEIR DIABETIC CONDITION, INCLUDING INFORMATION ON
11 MEDICAL NUTRITION THERAPY. THIS COVERAGE FOR SELF-MANAGEMENT
12 TRAINING AND MEDICAL NUTRITION THERAPY TRAINING IS LIMITED TO
13 VISITS MEDICALLY NECESSARY UPON THE DIAGNOSIS OF DIABETES, WHEN A
14 PHYSICIAN DIAGNOSES A SIGNIFICANT CHANGE IN THE PATIENT'S SYMP-
15 TOMS OR CONDITIONS THAT NECESSITATES CHANGES IN A PATIENT'S
16 SELF-MANAGEMENT, OR WHEN REEDUCATION OR REFRESHER TRAINING IS
17 NECESSARY AND IT IS RECOMMENDED OR PRESCRIBED BY A PHYSICIAN.
18 THE TRAINING MAY BE PROVIDED BY THE PHYSICIAN OR A MEMBER OF THE
19 PHYSICIAN'S STAFF AS PART OF AN OFFICE VISIT FOR DIABETES DIAGNO-
20 SIS OR TREATMENT OR BY A DIABETES OUTPATIENT TRAINING PROGRAM
21 CERTIFIED TO RECEIVE MEDICAID OR MEDICARE REIMBURSEMENT.
22 TRAINING PROVIDED BY AN OUTPATIENT DIABETIC SELF-MANAGEMENT PRO-
23 GRAM MAY BE LIMITED TO GROUP SETTINGS WHENEVER PRACTICABLE.
24 COVERAGE FOR SELF-MANAGEMENT TRAINING AND MEDICAL NUTRITION THER-
25 APY TRAINING ALSO INCLUDES HOME VISITS IF MEDICALLY NECESSARY.
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1 (2) BENEFITS UNDER THIS SECTION ARE NOT SUBJECT TO DOLLAR
2 LIMITS, DEDUCTIBLES, AND COPAYMENT PROVISIONS THAT ARE GREATER
3 THAN THOSE FOR PHYSICAL ILLNESS GENERALLY.
4 (3) AS USED IN THIS SECTION:
5 (A) "DIABETES" INCLUDES ALL OF THE FOLLOWING:
6 (i) GESTATIONAL DIABETES.
7 (ii) INSULIN-USING DIABETES.
8 (iii) NON-INSULIN-USING DIABETES.
9 (B) "MEDICAID" MEANS TITLE XIX OF THE SOCIAL SECURITY ACT,
10 CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1396 TO 1396f AND 1396g-1 TO
11 1396w.
12 (C) "MEDICARE" MEANS TITLE XVIII OF THE SOCIAL SECURITY ACT,
13 CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1395 TO 1395b, 1395b-2,
14 1395c TO 1395i, 1395i-2 TO 1395i-4, 1395j TO 1395t, 1395u TO
15 1395w-2, 1395w-4 TO 1395yy, AND 1395bbb TO 1395ddd.
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