HOUSE BILL No. 4161


     January 30, 1997, Introduced by Reps. Kilpatrick, Martinez, Hanley, Bogardus, Hale, Quarles, Thomas, Frank, Willard, Gagliardi, Schauer, Cherry, Bankes, Kukuk, Rocca, Raczkowski, Brewer, Rison and Parks and referred to the Committee on Insurance.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   (MCL 333.1101 to 333.25211) by adding section 21054u.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 21054U.  (1) A HEALTH MAINTENANCE ORGANIZATION SHALL

 2    PROVIDE COVERAGE IN EACH GROUP AND INDIVIDUAL CONTRACT 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 EDUCATION TO ENSURE THAT PER-

 9    SONS WITH DIABETES ARE EDUCATED AS TO THE PROPER SELF-MANAGEMENT

10    AND TREATMENT OF THEIR DIABETIC CONDITION, INCLUDING INFORMATION

11    ON PROPER DIETS.  THIS COVERAGE FOR SELF-MANAGEMENT EDUCATION AND

12    EDUCATION RELATING TO DIET SHALL BE LIMITED TO VISITS MEDICALLY

13    NECESSARY UPON THE DIAGNOSIS OF DIABETES, WHEN A PHYSICIAN DIAG-

14    NOSES A SIGNIFICANT CHANGE IN THE PATIENT'S SYMPTOMS OR CONDI-

15    TIONS THAT NECESSITATES CHANGES IN A PATIENT'S SELF-MANAGEMENT,

16    OR WHEN REEDUCATION OR REFRESHER EDUCATION IS NECESSARY.  THIS

17    EDUCATION MAY BE PROVIDED BY THE PHYSICIAN OR A MEMBER OF THE

18    PHYSICIAN'S STAFF AS PART OF AN OFFICE VISIT FOR DIABETES DIAGNO-

19    SIS OR TREATMENT OR BY A DIABETES OUTPATIENT EDUCATION PROGRAM

20    CERTIFIED TO RECEIVE MEDICAID OR MEDICARE REIMBURSEMENT.

21    EDUCATION PROVIDED BY AN OUTPATIENT DIABETIC SELF-MANAGEMENT

22    TRAINING PROGRAM MAY BE LIMITED TO GROUP SETTINGS WHENEVER

23    PRACTICABLE.  COVERAGE FOR SELF-MANAGEMENT EDUCATION AND EDUCA-

24    TION RELATING TO DIET SHALL ALSO INCLUDE HOME VISITS WHEN MEDI-

25    CALLY NECESSARY.

26         (2) COVERAGE UNDER THIS SECTION IS NOT SUBJECT TO DOLLAR

27    LIMITS, DEDUCTIBLES, AND COPAYMENT PROVISIONS THAT ARE GREATER



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 1    THAN THOSE FOR PHYSICAL ILLNESS GENERALLY, EXCEPT THAT INSULIN

 2    INFUSION PUMP COVERAGE MAY BE LIMITED TO THE PURCHASE OF 1 PUMP

 3    PER YEAR AND THE HEALTH MAINTENANCE ORGANIZATION MAY REQUIRE THE

 4    ENROLLEE TO USE A PUMP FOR 30 DAYS BEFORE PURCHASE.

 5         (3) AS USED IN THIS SECTION:

 6         (A) "MEDICAID" MEANS TITLE XIX OF THE SOCIAL SECURITY ACT,

 7    CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1396 TO 1396f AND 1396g-1 TO

 8    1396w.

 9         (B) "MEDICARE" MEANS TITLE XVIII OF THE SOCIAL SECURITY ACT,

10    CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1395 TO 1395b, 1395b-2,

11    1395c TO 1395i, 1395i-2 TO 1395i-4, 1395j TO 1395t, 1395u TO

12    1395w-2, 1395w-4 TO 1395yy, AND 1395bbb TO 1395ddd.
































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