PRIOR PRINTER'S NOS. 724, 2260, 2470          PRINTER'S NO. 2505

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

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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