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§ 15-822. Diabetes equipment, supplies, and outpatient self-management training and educational...

West's Annotated Code of MarylandInsuranceEffective: January 1, 2019

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 8. Required Health Insurance Benefits (Refs & Annos)
Effective: January 1, 2019
MD Code, Insurance, § 15-822
§ 15-822. Diabetes equipment, supplies, and outpatient self-management training and educational services
Currentness
Application of section
(a) This section applies to:
(1) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies that are issued or delivered in the State; and
(2) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
Coverage for diabetes equipment, supplies, and outpatient self-management training and educational services
(b) An entity subject to this section shall provide coverage for all medically appropriate and necessary diabetes equipment, diabetes supplies, and diabetes outpatient self-management training and educational services, including medical nutrition therapy, that the insured's or enrollee's treating physician or other appropriately licensed health care provider, or a physician who specializes in the treatment of diabetes, certifies are necessary for the treatment of:
(1) insulin-using diabetes;
(2) noninsulin-using diabetes;
(3) elevated or impaired blood glucose levels induced by pregnancy; or
(4) consistent with the American Diabetes Association's standards, elevated or impaired blood glucose levels induced by prediabetes.
Programs supervised by licensed, registered, or certified health care providers
(c) If certified as necessary under subsection (b) of this section, the diabetes outpatient self-management training and educational services, including medical nutrition therapy, to be provided to the insured or enrollee shall be provided through a program supervised by an appropriately licensed, registered, or certified health care provider whose scope of practice includes diabetes education or management.
Annual deductibles or coinsurance requirements
(d)(1) Subject to paragraph (2) of this subsection, and except as provided in paragraph (3) of this subsection, the coverage required under this section may be subject to the annual deductibles or coinsurance requirements imposed by an entity subject to this section for similar coverages under the same health insurance policy or contract.
(2) Except as provided in paragraph (3) of this subsection, the annual deductibles or coinsurance requirements imposed under paragraph (1) of this subsection for the coverage required under this section may not be greater than the annual deductibles or coinsurance requirements imposed by the entity for similar coverages.
(3)(i) Except as provided in subparagraph (ii) of this paragraph, an entity subject to this section may not impose a deductible, copayment, or coinsurance requirement on diabetes test strips.
(ii) If an insured or enrollee is covered under a high-deductible health plan, as defined in 26 U.S.C. § 223, an entity subject to this section may subject diabetes test strips to the deductible requirement of the high-deductible health plan.
Reduction or elimination of coverage prohibited
(e) An entity subject to this section may not reduce or eliminate coverages in its health insurance policies or contracts due to the requirements of this section.

Credits

Added by Acts 1997, c. 167, § 1, eff. Jan. 1, 1998; Acts 1997, c. 168, § 1. eff. Jan. 1, 1998. Amended by Acts 2017, c. 227, § 1, eff. Jan. 1, 2018; Acts 2018, c. 432, § 1, eff. Jan. 1, 2019; Acts 2018, c. 433, § 1, eff. Jan. 1, 2019.
MD Code, Insurance, § 15-822, MD INSURANCE § 15-822
Current through legislation effective through July 1, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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