BILL NUMBER: SB 1104	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 27, 2010

INTRODUCED BY   Senator Cedillo

                        FEBRUARY 17, 2010

   An act to amend Section 1367.51 of the Health and Safety Code, and
to amend Section 10176.61 of the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1104, as amended, Cedillo. Health care coverage:
diabetes-related complications.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires specified health care service plan contracts
and health insurance policies to provide coverage for certain
equipment, supplies, and medications for the treatment of diabetes,
including podiatric devices to prevent or treat diabetes-related
complications. Existing law also requires a plan or insurer to
provide coverage for diabetes outpatient self-management training,
education, and medical nutrition therapy necessary to enable an
enrollee or insured to properly use the equipment, supplies, and
medications.
   This bill would require health care service plan contracts and
health insurance policies to also provide coverage for the diagnosis
and treatment of diabetes-related complications, as 
specified   defined  . Because a willful violation
of this requirement by a health care service plan would be a crime,
the bill would impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.51 of the Health and Safety Code is
amended to read:
   1367.51.  (a) Every health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, delivered, or renewed on or after January 1, 2000, and that
covers hospital, medical, or surgical expenses shall include coverage
for the following equipment and supplies for the management and
treatment of insulin-using diabetes, non-insulin-using diabetes, and
gestational diabetes as medically necessary, even if the items are
available without a prescription:
   (1) Blood glucose monitors and blood glucose testing strips.
   (2) Blood glucose monitors designed to assist the visually
impaired.
   (3) Insulin pumps and all related necessary supplies.
   (4) Ketone urine testing strips.
   (5) Lancets and lancet puncture devices.
   (6) Pen delivery systems for the administration of insulin.
   (7) Podiatric devices to prevent or treat diabetes-related
complications.
   (8) Insulin syringes.
   (9) Visual aids, excluding eyewear, to assist the visually
impaired with proper dosing of insulin.
   (b) Every health care service plan contract, except a specialized
health care service plan contract, that is issued, amended,
delivered, or renewed on or after January 1, 2000, that covers
prescription benefits shall include coverage for the following
prescription items if the items are determined to be medically
necessary:
   (1) Insulin.
   (2)  Prescription medications for the treatment of diabetes.
   (3) Glucagon.
   (c) Every health care service plan contract, except a specialized
health care service plan contract, that is issued, amended,
delivered, or renewed on or after January 1, 2011, and that covers
hospital, medical, or surgical expenses, shall provide coverage for
the diagnosis and treatment of diabetes-related complications. With
respect to contracts that cover prescription benefits, the coverage
required by this subdivision shall include coverage of prescription
medications for the treatment of diabetes-related complications. 
Nothing in this subdivision shall be construed to require a health
care service plan contract that does not provide an outpatient
pharmacy benefit to provide that benefit.  For purposes of this
subdivision, "diabetes-related  complications" includes, but
is not limited to, diabetic peripheral neuropathy.  
complications" means any conditions of a diabetic patient for which
diabetes is a major risk factor. 
   (d) The copayments and deductibles for the benefits specified in
subdivisions (a), (b), and (c) shall not exceed those established for
similar benefits within the given plan.
   (e) Every plan shall provide coverage for diabetes outpatient
self-management training, education, and medical nutrition therapy
necessary to enable an enrollee to properly use the equipment,
supplies, and medications set forth in subdivisions (a) and (b), and
additional diabetes outpatient self-management training, education,
and medical nutrition therapy upon the direction or prescription of
those services by the enrollee's participating physician. If a plan
delegates outpatient self-management training to contracting
providers, the plan shall require contracting providers to ensure
that diabetes outpatient self-management training, education, and
medical nutrition therapy are provided by appropriately licensed or
registered health care professionals.
   (f) The diabetes outpatient self-management training, education,
and medical nutrition therapy services identified in subdivision (e)
shall be provided by appropriately licensed or registered health care
professionals as prescribed by a participating health care
professional legally authorized to prescribe the service. These
benefits shall include, but not be limited to, instruction that will
enable diabetic patients and their families to gain an understanding
of the diabetic disease process, and the daily management of diabetic
therapy, in order to thereby avoid frequent hospitalizations and
complications.
   (g) The copayments for the benefits specified in subdivision (e)
shall not exceed those established for physician office visits by the
plan.
   (h) Every health care service plan governed by this section shall
disclose the benefits covered pursuant to this section in the plan's
evidence of coverage and disclosure forms.
   (i) A health care service plan may not reduce or eliminate
coverage as a result of the requirements of this section.
   (j) Nothing in this section shall be construed to deny or restrict
in any way the department's authority to ensure plan compliance with
this chapter when a plan provides coverage for prescription drugs.
  SEC. 2.  Section 10176.61 of the Insurance Code is amended to read:

   10176.61.  (a) Every insurer issuing, amending, delivering, or
renewing a health insurance policy on or after January 1, 2000, shall
include coverage for the following equipment and supplies for the
management and treatment of insulin-using diabetes, non-insulin-using
diabetes, and gestational diabetes as medically necessary, even if
the items are available without a prescription:
   (1) Blood glucose monitors and blood glucose testing strips.
   (2) Blood glucose monitors designed to assist the visually
impaired.
   (3) Insulin pumps and all related necessary supplies.
   (4) Ketone urine testing strips.
   (5) Lancets and lancet puncture devices.
   (6) Pen delivery systems for the administration of insulin.
   (7) Podiatric devices to prevent or treat diabetes-related
complications.
   (8) Insulin syringes.
   (9) Visual aids, excluding eyewear, to assist the visually
impaired with proper dosing of insulin.
   (b) Every insurer issuing, amending, delivering, or renewing a
health insurance policy on or after January 1, 2000, that covers
prescription benefits shall include coverage for the following
prescription items if the items are determined to be medically
necessary:
   (1) Insulin.
   (2) Prescription medications for the treatment of diabetes.
   (3) Glucagon.
   (c) Every health insurance policy that is issued, amended,
delivered, or renewed on or after January 1, 2011, shall provide
coverage for the diagnosis and treatment of diabetes-related
complications. With respect to policies that cover prescription
benefits, the coverage required by this subdivision shall include
coverage of prescription medications for the treatment of
diabetes-related complications.  Nothing in this subdivision
shall be construed to require a health insurance policy that does not
provide an outpatient pharmacy benefit to provide   that
benefit.  For purposes of this subdivision, "diabetes-related
complications"  includes, but is not limited to, diabetic
peripheral neuropathy.   means any conditions of a
diabetic patient for which diabetes is a major risk factor. 
   (d) The coinsurances and deductibles for the benefits specified in
subdivisions (a), (b), and (c) shall not exceed those established
for similar benefits within the given policy.
   (e) Every health insurer shall provide coverage for diabetes
outpatient self-management training, education, and medical nutrition
therapy necessary to enable an insured to properly use the
equipment, supplies, and medications set forth in subdivisions (a)
and (b) and additional diabetes outpatient self-management training,
education, and medical nutrition therapy upon the direction or
prescription of those services by the insured's participating
physician. If a health insurer delegates outpatient self-management
training to contracting providers, the insurer shall require
contracting providers to ensure that diabetes outpatient
self-management training, education, and medical nutrition therapy
are provided by appropriately licensed or registered health care
professionals.
   (f) The diabetes outpatient self-management training, education,
and medical nutrition therapy services identified in subdivision (e)
shall be provided by appropriately licensed or registered health care
professionals as prescribed by a health care professional legally
authorized to prescribe the services.
   (g) The coinsurances and deductibles for the benefits specified in
subdivision (e) shall not exceed those established for physician
office visits by the insurer.
   (h) Every health insurer governed by this section shall disclose
the benefits covered pursuant to this section in the insurer's
evidence of coverage and disclosure forms.
   (i) A health insurer may not reduce or eliminate coverage as a
result of the requirements of this section.
   (j) This section does not apply to vision-only, dental-only,
accident-only, specified disease, hospital indemnity, Medicare
supplement, long-term care, or disability income insurance, except
that for accident-only, specified disease, and hospital indemnity
insurance coverage, benefits under this section only apply to the
extent that the benefits are covered under the general terms and
conditions that apply to all other benefits under the policy. Nothing
in this section may be construed as imposing a new benefit mandate
on accident-only, specified disease, or hospital indemnity insurance.

  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.