514C.18  DIABETES COVERAGE.
         1.  Notwithstanding the uniformity of treatment requirements of
      section 514C.6, a policy or contract providing for third-party
      payment or prepayment of health or medical expenses shall provide
      coverage benefits for the cost associated with equipment, supplies,
      and self-management training and education for the treatment of all
      types of diabetes mellitus when prescribed by a physician licensed
      under chapter 148, 150, or 150A.  Coverage benefits shall include
      coverage for the cost associated with all of the following:
         a.  Blood glucose meter and glucose strips for home
      monitoring.
         b.  Payment for diabetes self-management training and
      education only under all of the following conditions:
         (1)  The physician managing the individual's diabetic condition
      certifies that such services are needed under a comprehensive plan of
      care related to the individual's diabetic condition to ensure therapy
      compliance or to provide the individual with necessary skills and
      knowledge to participate in the management of the individual's
      condition.
         (2)  The diabetic self-management training and education program
      is certified by the Iowa department of public health.  The department
      shall consult with the American diabetes association, Iowa affiliate,
      in developing the standards for certification of diabetes education
      programs as follows:
         (a)  Initial training shall cover up to ten hours of initial
      outpatient diabetes self-management training within a continuous
      twelve-month period for each individual that meets any of the
      following conditions:
         (i)  A new onset of diabetes.
         (ii)  Poor glycemic control as evidenced by a glycosylated
      hemoglobin of nine and five-tenths or more in the ninety days before
      attending the training.
         (iii)  A change in treatment regimen from no diabetes medications
      to any diabetes medication, or from oral diabetes medication to
      insulin.
         (iv)  High risk for complications based on poor glycemic control;
      documented acute episodes of severe hypoglycemia or acute severe
      hyperglycemia occurring in the past year during which the individual
      needed third-party assistance for either emergency room visits or
      hospitalization.
         (v)  High risk based on documented complications of a lack of
      feeling in the foot or other foot complications such as foot ulcer or
      amputation, pre-proliferative or proliferative retinopathy or prior
      laser treatment of the eye, or kidney complications related to
      diabetes, such as macroalbuminuria or elevated creatinine.
         (b)  An individual who receives the initial training shall be
      eligible for a single follow-up training session of up to one hour
      each year.
         2. a.  This section applies to the following classes of
      third-party payment provider contracts or policies delivered, issued
      for delivery, continued, or renewed in this state on or after July 1,
      1999:
         (1)  Individual or group accident and sickness insurance providing
      coverage on an expense-incurred basis.
         (2)  An individual or group hospital or medical service contract
      issued pursuant to chapter 509, 514, or 514A.
         (3)  An individual or group health maintenance organization
      contract regulated under chapter 514B.
         (4)  Any other entity engaged in the business of insurance, risk
      transfer, or risk retention, which is subject to the jurisdiction of
      the commissioner.
         (5)  A plan established pursuant to chapter 509A for public
      employees.
         (6)  An organized delivery system licensed by the director of
      public health.
         b.  This section shall not apply to accident-only, specified
      disease, short-term hospital or medical, hospital confinement
      indemnity, credit, dental, vision, Medicare supplement, long-term
      care, basic hospital and medical-surgical expense coverage as defined
      by the commissioner, disability income insurance coverage, coverage
      issued as a supplement to liability insurance, workers' compensation
      or similar insurance, or automobile medical payment insurance.  

         Section History: Recent Form

         99 Acts, ch 75, §1; 99 Acts, ch 208, §58