GENERAL ASSEMBLY OF NORTH CAROLINA
1997 SESSION

S.L. 1997-225
HOUSE BILL 5

AN ACT TO REQUIRE CERTAIN COVERAGE FOR DIABETES IN HEALTH AND ACCIDENT INSURANCE POLICIES, IN HOSPITAL OR MEDICAL SERVICES PLANS, AND IN HMO PLANS.

The General Assembly of North Carolina enacts:

Section 1.  Article 51 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-51-61.  Coverage for certain treatment for diabetes.
(a)	Every policy or contract of accident or health insurance, and every preferred provider contract, policy, or plan as defined and regulated under G.S. 58-50-50 and G.S. 58-50-55, that is issued, renewed, or amended on or after October 1, 1997, shall provide coverage for medically appropriate and necessary services, including diabetes outpatient self-management training and educational services, and equipment, supplies, medications, and laboratory procedures used to treat diabetes. Diabetes outpatient self-management training and educational services shall be provided by a physician or a health care professional designated by the physician. The insurer shall determine who shall provide and be reimbursed for the diabetes outpatient self-management training and educational services. The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b)	For the purposes of this section, 'physician' is a person licensed to practice in this State under Article 1 or Article 7 of Chapter 90 of the General Statutes."
Section 2.  Article 65 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-65-91.  Coverage for certain treatment of diabetes.
(a)	Every insurance certificate or subscriber contract under any hospital service plan or medical service plan governed by this Article and Article 66 of this Chapter, and every preferred provider contract, policy, or plan as defined and regulated under G.S. 58-50-50 and G.S. 58-50-55, that is issued, renewed, or amended on or after October 1, 1997, shall provide coverage for medically appropriate and necessary services, including diabetes outpatient self-management training and educational services, and equipment, supplies, medications, and laboratory procedures used to treat diabetes.  Diabetes outpatient self-management training and educational services shall be provided by a physician or a health care professional designated by the physician.  The hospital or medical service plan shall determine who shall provide and be reimbursed for the diabetes outpatient self-management training and educational services.  The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b)	For the purposes of this section, 'physician' is a person licensed to practice in this State under Article 1 or Article 7 of Chapter 90 of the General Statutes."
Section 3.  Article 67 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-67-74.  Coverage for certain treatment of diabetes.
(a)	Every health care plan written by a health maintenance organization and in force, issued, renewed, or amended on or after October 1, 1997, that is subject to this Article, shall provide coverage for medically appropriate and necessary services, including diabetes outpatient self-management training and educational services, and equipment, supplies, medications, and laboratory procedures used to treat diabetes.  Diabetes outpatient self-management training and educational services shall be provided by a physician or a health care professional designated by the physician.  The health maintenance organization shall determine who shall provide and be reimbursed for the diabetes outpatient self-management training and educational services.  The same deductibles, coinsurance, and other limitations as apply to similar services covered under the policy, contract, or plan shall apply to the diabetes coverage required under this section.
(b)	For the purposes of this section, 'physician' is a person licensed to practice in this State under Article 1 or Article 7 of Chapter 90 of the General Statutes."
Section 4.  Nothing in this act shall apply to specified accident, specified disease, hospital indemnity, or long-term care health insurance policies.
Section 5. The North Carolina Commission for Health Services shall develop voluntary standards or guidelines for diabetes outpatient self-management training and educational services based on clinical practice recommendations and guidelines established by the Center for Disease Control and the American Diabetes Association.  These standards or guidelines are not subject to Article 2A of Chapter 150B of the General Statues.
Section 6.  This act is effective when it becomes law.
In the General Assembly read three times and ratified this the 16th day of June, 1997.
s/	Dennis A. Wicker
President of the Senate

s/	Harold J. Brubaker
Speaker of the House of Representatives

s/	James B. Hunt, Jr.
Governor

Approved 4:00 p.m. this 26th day of June, 1997