Michigan Laws 500.3406p – Establishment of program to prevent onset of clinical diabetes required; survey; coverages; “diabetes” defined
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 500.3406p
- Department: means the department of insurance and financial services. See Michigan Laws 500.102
- Health insurance policy: means an expense-incurred hospital, medical, or surgical policy, certificate, or contract. See Michigan Laws 500.608
- Insurer: means an individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds organization, fraternal benefit society, or other legal entity, engaged or attempting to engage in the business of making insurance or surety contracts. See Michigan Laws 500.106
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall establish and provide to insureds, enrollees, and affiliated providers a program to prevent the onset of clinical diabetes. This program for affiliated providers must emphasize best practice guidelines to prevent the onset of clinical diabetes and to treat diabetes, including, but not limited to, diet, lifestyle, physical exercise and fitness, and early diagnosis and treatment.
(2) An insurer that provides a program under subsection (1) shall regularly measure the effectiveness of the program by regularly surveying individuals covered by the health insurance policy.
(3) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall include coverage for the following equipment, supplies, and educational training for the treatment of diabetes, if determined to be medically necessary and prescribed by an allopathic or osteopathic physician:
(a) Blood glucose monitors and blood glucose monitors for the legally blind.
(b) Test strips for glucose monitors, visual reading and urine testing strips, lancets, and spring-powered lancet devices.
(c) Syringes.
(d) Insulin pumps and medical supplies required for the use of an insulin pump.
(e) Diabetes self-management training to ensure that persons with diabetes are trained as to the proper self-management and treatment of their diabetic condition.
(4) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides outpatient pharmaceutical coverage directly or by rider shall include the following coverage for the treatment of diabetes, if determined to be medically necessary:
(a) Insulin, if prescribed by an allopathic or osteopathic physician.
(b) Nonexperimental medication for controlling blood sugar, if prescribed by an allopathic or osteopathic physician.
(c) Medications used in the treatment of foot ailments, infections, and other medical conditions of the foot, ankle, or nails associated with diabetes, if prescribed by an allopathic, osteopathic, or podiatric physician.
(5) Coverage under subsection (3) for diabetes self-management training is subject to all of the following:
(a) The training is limited to completion of a certified diabetes education program if either of the following applies:
(i) The training is considered medically necessary upon the diagnosis of diabetes by an allopathic or osteopathic physician who is managing the patient’s diabetic condition and is needed under a comprehensive plan of care to ensure therapy compliance or to provide necessary skills and knowledge.
(ii) An allopathic or osteopathic physician has diagnosed a significant change with long-term implications in the patient’s symptoms or conditions that necessitates changes in the patient’s self-management or a significant change in medical protocol or treatment modalities.
(b) The training must be provided by a diabetes outpatient training program certified to receive Medicaid or Medicare reimbursement or certified by the department of community health. Training provided under this subdivision must be conducted in group settings whenever practicable.
(6) Coverage under this section is not subject to dollar limits, deductibles, or copayment provisions that are greater than those for physical illness generally.
(7) As used in this section, “diabetes” includes all of the following:
(a) Gestational diabetes.
(b) Insulin-dependent diabetes.
(c) Non-insulin-dependent diabetes.