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90_SB1048ham002
LRB9005120JSdvam01
1 AMENDMENT TO SENATE BILL 1048
2 AMENDMENT NO. . Amend Senate Bill 1048, AS AMENDED,
3 by replacing Section 5 of the bill with the following:
4 "Section 5. The Illinois Insurance Code is amended by
5 adding Section 356t as follows:
6 (215 ILCS 5/356t new)
7 Sec. 356t. Diabetes self-management training and
8 education.
9 (a) A group policy of accident and health insurance that
10 is amended, delivered, issued, or renewed after the effective
11 date of this amendatory Act of 1997 shall provide coverage
12 for outpatient self-management training and education,
13 equipment, and supplies, as set forth in this Section, for
14 the treatment of insulin-dependent diabetes, insulin-using
15 diabetes, gestational diabetes, and non-insulin-using
16 diabetes.
17 (b) As used in this Section, "diabetes self-management
18 training" means instruction in an outpatient setting which
19 enables diabetic patients to understand the diabetes
20 management process and daily management of diabetic therapy
21 as a means of avoiding frequent hospitalizations and
22 complications. Diabetes self-management training shall
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1 include, but shall not be limited to, medical nutrition
2 therapy.
3 As used in this Section, "medical nutrition therapy"
4 shall have the meaning ascribed to "medical nutrition care"
5 in the Dietetic and Nutrition Services Practice Act. With
6 respect to an insurer or health maintenance organization that
7 does not use a primary care physician to control access to
8 specialty care, "attending physician" means (i) a network
9 physician licensed to practice medicine in all its branches
10 or (ii) a certified, registered, or licensed health care
11 professional with expertise in diabetes management to whom
12 the individual has been referred by the attending physician.
13 As used in this Section, "attending physician" means a
14 physician licensed to practice medicine in all of its
15 branches providing care to the individual. The attending
16 physician for an individual enrolled in a health maintenance
17 organization shall be the individual's primary care
18 physician.
19 (c) Coverage under this Section for diabetes
20 self-management training, including medical nutrition
21 therapy, shall be limited to the following:
22 (1) Up to 3 medically necessary visits upon initial
23 diagnosis of diabetes by the patient's attending
24 physician, which are provided by the attending physician
25 or on the referral of the attending physician by a
26 physician licensed to practice medicine in all of its
27 branches or on the referral of the attending physician by
28 a certified, registered, or licensed health care
29 professional with expertise in diabetes management.
30 (2) Up to 2 medically necessary visits, upon a
31 diagnosis by a patient's attending physician that
32 represents a significant change in the patient's symptoms
33 or condition, which are provided by the attending
34 physician or on the referral of the attending physician
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1 by a physician licensed to practice medicine in all of
2 its branches or on the referral of the attending
3 physician by a certified, registered, or licensed health
4 care professional with expertise in diabetes management.
5 Payment for the coverage required for diabetes
6 self-management training pursuant to the provisions of this
7 Section may be required only upon certification by the health
8 care provider providing the training that the patient has
9 successfully completed diabetes self-management training.
10 (d) Coverage shall be provided for the following
11 equipment, supplies, and related services when medically
12 necessary and prescribed by a physician licensed to practice
13 medicine in all of its branches:
14 (1) blood glucose monitors;
15 (2) blood glucose monitors for the legally blind;
16 (3) cartridges for the legally blind;
17 (4) FDA approved oral agents used to control blood
18 sugar, if an individual's policy of accident and health
19 insurance provides a drug benefit;
20 (5) insulin, if an individual's policy of accident
21 and health insurance provides a drug benefit;
22 (6) insulin infusion devices;
23 (7) glucose tablets, glucagon emergency kits and
24 injectable glucose;
25 (8) insulin pumps and appurtenances;
26 (9) regular foot care exams;
27 (10) syringes, pen needles, lancets, and lancing
28 devices, if an individual's policy of accident and health
29 insurance contains a drug benefit;
30 (11) test strips for glucose monitors, if an
31 individual's policy of accident and health insurance
32 contains a drug benefit;
33 (12) visual reading and urine testing strips.
34 Diabetes self-management training may be provided as part
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1 of an office visit, group setting, or in-home visit.
2 (e) This Section does not restrict or prohibit any
3 person licensed in this State under any other Act from
4 engaging in the practice for which that person is licensed.";
5 and
6 by replacing Section 99 of the bill with the following:
7 "Section 99. Effective date. This Act takes effect
8 January 1, 1998.".