Sec. 416b.
(1) A health care corporation shall establish and provide to members and participating providers a program to prevent the onset of clinical diabetes. This program for participating providers shall 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) A health care corporation shall regularly measure the effectiveness of a program provided pursuant to subsection (1) by regularly surveying group and nongroup members covered by the certificate. Not later than 2 years after the effective date of the amendatory act that added this section, each health care corporation shall prepare a report containing the results of the survey and shall provide a copy of the report to the department of community health.
(3) A health care corporation certificate shall provide benefits in each group and nongroup certificate 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) Insulin.
(d) Syringes.
(e) Insulin pumps and medical supplies required for the use of an insulin pump.
(f) Nonexperimental medication for controlling blood sugar.
(g) 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) A health care corporation certificate shall provide benefits in each group and nongroup certificate for medically necessary medications prescribed by an allopathic, osteopathic, or podiatric physician and used in the treatment of foot ailments, infections, and other medical conditions of the foot, ankle, or nails associated with diabetes.
(5) Coverage under subsection (3) for diabetes self-management training is subject to all of the following:
(a) Is limited to completion of a certified diabetes education program upon occurrence of either of the following:
(i) If considered medically necessary upon the diagnosis of diabetes by an allopathic or osteopathic physician who is managing the patient's diabetic condition and if the services are needed under a comprehensive plan of care to ensure therapy compliance or to provide necessary skills and knowledge.
(ii) If an allopathic or osteopathic physician diagnoses a significant change with long-term implications in the patient's symptoms or conditions that necessitates changes in a patient's self-management or a significant change in medical protocol or treatment modalities.
(b) Shall be provided by a diabetes outpatient training program certified to receive medicare or medicaid reimbursement or certified by the department of community health. Training provided under this subdivision shall be conducted in group settings whenever practicable.
(6) Benefits under this section are 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.
History: Add. 2000, Act 424, Eff. Mar. 28, 2001
Popular Name: Blue Cross-Blue Shield
Popular Name: Act 350