PRIOR PRINTER'S NOS. 724, 2260, 2470 PRINTER'S NO. 2505
No. 656 Session of 1997
INTRODUCED BY M. N. WRIGHT, MICOZZIE, O'BRIEN, E. Z. TAYLOR, GEORGE, DeLUCA, STABACK, COWELL, GEIST, HALUSKA, STERN, LEDERER, WALKO, OLASZ, FAIRCHILD, BISHOP, KENNEY, MELIO, NAILOR, ALLEN, YOUNGBLOOD, CURRY, SANTONI, TIGUE, McCALL, LYNCH, THOMAS, ITKIN, JOSEPHS, TRELLO, FEESE, RAYMOND, HENNESSEY, STEELMAN, ROEBUCK, JAMES, PISTELLA, J. TAYLOR, SERAFINI, TRAVAGLIO, BOSCOLA, CIVERA, BENNINGHOFF, COLAFELLA, PRESTON, ROSS, ROONEY, HORSEY, LAUGHLIN, EVANS, BUXTON, STEVENSON, HERMAN, BAKER, BLAUM, CHADWICK, ZIMMERMAN, KAISER, VEON, PERZEL, ORIE, McILHATTAN, BARD, MAJOR, BROWNE, HABAY, HASAY, LESCOVITZ, DERMODY, SEYFERT, CORPORA, LaGROTTA, STRITTMATTER, GIGLIOTTI, MARKOSEK, READSHAW, PIPPY, SAYLOR, RUBLEY, EACHUS, WILT, DeWEESE, PETRARCA, TRICH, BARRAR, KREBS, TRUE, PLATTS, L. I. COHEN, BELARDI, COY, VAN HORNE, C. WILLIAMS, FLEAGLE, DENT, BOYES, SAINATO, HESS, SCRIMENTI, PESCI, JAROLIN, CAPPABIANCA, GORDNER, COLAIZZO, MILLER, MAYERNIK, D. W. SNYDER, PHILLIPS, DALLY AND LEVDANSKY, FEBRUARY 28, 1997
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES, OCTOBER 27, 1997
AN ACT 1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An 2 act relating to insurance; amending, revising, and 3 consolidating the law providing for the incorporation of 4 insurance companies, and the regulation, supervision, and 5 protection of home and foreign insurance companies, Lloyds 6 associations, reciprocal and inter-insurance exchanges, and 7 fire insurance rating bureaus, and the regulation and 8 supervision of insurance carried by such companies, 9 associations, and exchanges, including insurance carried by 10 the State Workmen's Insurance Fund; providing penalties; and 11 repealing existing laws," providing for reimbursement for 12 diabetic supplies AND FOR HEARING AID COVERAGE. <-- 13 The General Assembly of the Commonwealth of Pennsylvania 14 hereby enacts as follows:
1 Section 1. The act of May 17, 1921 (P.L.682, No.284), known 2 as The Insurance Company Law of 1921, is amended by adding a <-- 3 section SECTIONS to read: <-- 4 Section 633. Reimbursement for Diabetic Supplies.--(a) 5 Except to the extent already covered under another policy, any 6 individual or group health, sickness and accident insurance 7 policy, group health insurance plans/policies, and all other 8 forms of managed/capitated care plans/policies or subscriber 9 contract or certificate issued by any entity subject to 40 10 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 11 (relating to professional health services plan corporations) or 12 the act of December 29, 1972 (P.L.1701, No.364), known as the 13 "Health Maintenance Organization Act," the act of December 14, 14 1992 (P.L.835, No.134), known as the "Fraternal Benefit 15 Societies Code," or this act, providing hospital or 16 medical/surgical coverage, shall provide coverage of the 17 equipment, supplies and outpatient self-management training and 18 education, including medical nutrition therapy for the treatment 19 of insulin-dependent diabetes, insulin-using diabetes, 20 gestational diabetes and noninsulin-using diabetes if prescribed 21 by a health care professional legally authorized to prescribe 22 such items under law. The benefits specified in this section may 23 be provided through a combination of policies, contracts, 24 certificates or riders, including major medical contracts. 25 (b) This section does not include the following policies: 26 accident only, fixed indemnity, limited benefit, credit, dental, 27 vision, specified disease, Medicare supplement, CHAMPUS 28 (Civilian Health and Medical Program for the Uniform Services) 29 supplement, long-term care, disability income, workers' 30 compensation or automobile medical payment. 19970H0656B2505 - 2 -
1 (c) Equipment and supplies shall include the following: 2 blood glucose monitors, monitor supplies, insulin, injection 3 aids, syringes, insulin infusion devices, pharmacological agents 4 for controlling blood sugar and orthodics. 5 (d) Diabetes outpatient self-management training and 6 education shall be provided under the supervision of a licensed 7 health care professional with expertise in diabetes to ensure 8 that persons with diabetes are educated as to the proper self- 9 management and treatment of their diabetes, including 10 information on proper diets. Coverage for self-management 11 education and education relating to diet and prescribed by a 12 licensed physician shall include: 13 (1) visits medically necessary upon the diagnosis of 14 diabetes; 15 (2) visits under circumstances whereby a physician 16 identifies or diagnoses a significant change in the patient's 17 symptoms or conditions that necessitates changes in a patient's 18 self-management; and 19 (3) where a new medication or therapeutic process relating 20 to the person's treatment and/or management of diabetes has been 21 identified as medically necessary by a licensed physician. 22 (e) The coverage required under this section shall be 23 subject to the annual deductibles or coinsurance requirements 24 imposed by an entity subject to this section for similar 25 coverages under the same health insurance policy or contract. 26 SECTION 634. HEARING AID COVERAGE.--ANY INSURER THAT <-- 27 UNDERWRITES MEDICARE OR MEDICAID INSURANCE FOR INSUREDS RESIDING 28 IN THIS COMMONWEALTH SHALL PROVIDE COVERAGE IN SUCH INSURANCE 29 FOR A HEARING AID SOLD IN ACCORDANCE WITH SECTION 403 OF THE ACT 30 OF NOVEMBER 24, 1976 (P.L.1182, NO.262), KNOWN AS THE "HEARING 19970H0656B2505 - 3 -
1 AID SALES REGISTRATION LAW."
2 Section 2. This act shall take effect in 120 days.
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