Coverage for Equipment and Self-Management Training for Individuals With Diabetes; Enforcement

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Coverage for Equipment and Self-Management Training for Individuals With Diabetes; Enforcement

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  1. Every individual major medical and group health insurance policy, group health insurance plan or policy, and any other form of managed or capitated care plans or policies shall provide coverage for medically necessary equipment, supplies, pharmacologic agents, and outpatient self-management training and education, including medical nutrition therapy, for individuals with insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes who adhere to the prognosis and treatment regimen prescribed by a physician licensed to practice medicine pursuant to Title 43.
    1. Diabetes outpatient self-management training and education as provided for in subsection (a) of this Code section shall be provided by a certified, registered, or licensed health care professional with expertise in diabetes.
    2. The Commissioner shall promulgate rules and regulations after consultation with the Department of Public Health which conform to the standards for diabetes outpatient self-management training and educational services established by the American Diabetes Association for purposes of this Code section.
    3. The Commissioner shall promulgate rules and regulations, relating to standards of diabetes care,after consultation with the Department of Public Health, the American Diabetes Association, and the National Institutes of Health.Such rules and regulations shall be adopted in accordance with the provisions of Code Section 33-2-9.
  3. The benefits provided in this Code section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.
  4. Private third-party payors may not reduce or eliminate coverage due to the requirements of this Code section.
  5. Enforcement of the provisions of this Code section shall be performed by the Commissioner of Insurance.

(Code 1981, §33-24-59.2, enacted by Ga. L. 1998, p. 660, § 1; Ga. L. 2002, p. 646, § 1; Ga. L. 2009, p. 453, § 1-42/HB 228; Ga. L. 2011, p. 705, § 6-3/HB 214; Ga. L. 2019, p. 386, § 63/SB 133.)

The 2019 amendment, effective July 1, 2019, substituted "Every" for "On or after July 1, 2002, every" at the beginning of subsection (a); in paragraph (b)(2), substituted "The Commissioner" for "The office of the Commissioner of Insurance" at the beginning, deleted "current" following "conform to the" in the middle; and rewrote paragraph (b)(3), which read: "The office of the Commissioner of Insurance shall promulgate rules and regulations, relating to standards of diabetes care, to become effective July 1, 2002, after consultation with the Department of Human Resources (now known as the Department of Public Health for these purposes), the American Diabetes Association, and the National Institutes of Health. Such rules and regulations shall be adopted in accordance with the provisions of Code Section 33-2-9."

Code Commission notes.

- Ga. L. 1998, p. 649; Ga. L. 1998, p. 660; and Ga. L. 1998, p. 1382 each enacted a Code section designated as Code Section 33-24-59.1. Pursuant to Code Section 28-9-5, in 1998, the version enacted by Ga. L. 1998, p. 649 retained the designation as Code Section 33-24-59.1, the version enacted by Ga. L. 1998, p. 660 was redesignated as Code Section 33-24-59.2, and the version enacted by Ga. L. 1998, p. 1382 was redesignated as Code Section 33-24-59.3.

Law reviews.

- For article on the 2011 amendment of this Code section, see 28 Ga. St. U.L. Rev. 147 (2011). For note on the 2002 amendment of this Code section, see 19 Ga. St. U.L. Rev. 232 (2002).


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