BILL NUMBER: SB 64	ENROLLED
	BILL TEXT

	PASSED THE SENATE   SEPTEMBER 10, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 9, 1999
	AMENDED IN ASSEMBLY   SEPTEMBER 9, 1999
	AMENDED IN ASSEMBLY   SEPTEMBER 7, 1999
	AMENDED IN ASSEMBLY   JULY 8, 1999
	AMENDED IN SENATE   MAY 19, 1999
	AMENDED IN SENATE   APRIL 12, 1999
	AMENDED IN SENATE   MARCH 15, 1999
	AMENDED IN SENATE   FEBRUARY 25, 1999

INTRODUCED BY   Senators Solis and Sher
   (Coauthors:  Senators Baca, Bowen, Dunn, Escutia, Figueroa,
Hughes, Ortiz, Perata, Polanco, and Rainey)
   (Coauthors:  Assembly Members Alquist, Aroner, Cardoza, Correa,
Davis, Dutra, Firebaugh, Floyd, Gallegos, Honda, Jackson, Knox,
Kuehl, Lempert, Machado, Margett, Romero, Soto, Steinberg,
Strom-Martin, Washington, Wayne, and Wildman)

                        DECEMBER 7, 1998

   An act to add Section 1367.51 to the Health and Safety Code, and
to add Section 10176.61 to the Insurance Code, relating to health
insurance.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 64, Solis.  Health insurance:  management and treatment of
diabetes.
   (1) Existing law provides for the licensure and regulation of
health care service plans administered by the Commissioner of
Corporations.  Under existing law, a willful violation of any of
these provisions is punishable as either a felony or a misdemeanor.
Existing law provides for the regulation of policies of disability
insurance administered by the Insurance Commissioner.
   Existing law requires that health care service plans and
disability insurers provide coverage for certain benefits and
services.  Existing law also requires that disability insurers offer
coverage for diabetic day care self-management education programs.
   This bill would require all policies and plans, except as
specified, issued, amended, delivered, or renewed on and after
January 1, 2000, that cover hospital, medical, or surgical expenses,
to provide coverage for specified equipment and supplies for the
management and treatment of diabetes  as medically necessary.  This
bill would also require those policies and plans that cover
prescription drugs to also include specified prescription medications
for the treatment of diabetes  if the items are determined to be
medically necessary.  It would also require all policies and plans to
provide self-management training, education, and medical nutrition
therapy in this regard.
   Since a willful violation of the bill's coverage-related
requirements with respect to health care service plans would be a
crime, the bill would impose a state-mandated local program.
  (2) 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.


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


  SECTION 1.  Section 1367.51 is added to the Health and Safety Code,
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) Prescriptive medications for the treatment of diabetes.
   (3) Glucagon.
   (c) The copayments and deductibles for the benefits specified in
subdivisions (a) and (b) shall not exceed those established for
similar benefits within the given plan.
   (d) 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.
   (e) The diabetes outpatient self-management training, education,
and medical nutrition therapy services identified in subdivision (d)
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.
   (f) The copayments for the benefits specified in subdivision (d)
shall not exceed those established for physician office visits by the
plan.
   (g) 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.
   (h) A health care service plan may not reduce or eliminate
coverage as a result of the requirements of this section.
  SEC. 2.  Section 10176.61 is added to the Insurance Code, to read:

   10176.61.  (a) Every insurer issuing, amending, delivering, or
renewing a disability insurance policy on or after January 1, 2000,
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 insurer issuing, amending, delivering, or renewing a
disability 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) Prescriptive medications for the treatment of diabetes.
   (3) Glucagon.
   (c) The coinsurances and deductibles for the benefits specified in
subdivisions (a) and (b) shall not exceed those established for
similar benefits within the given policy.
   (d) Every 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 an
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.
   (e) The diabetes outpatient self-management training, education,
and medical nutrition therapy services identified in subdivision (d)
shall be provided by appropriately licensed or registered health care
professionals as prescribed by a health care professional legally
authorized to prescribe the services.
   (f) The coinsurances and deductibles for the benefits specified in
subdivision (d) shall not exceed those established for physician
office visits by the insurer.
   (g) Every disability insurer governed by this section shall
disclose the benefits covered pursuant to this section in the insurer'
s evidence of coverage and disclosure forms.
   (h) An insurer may not reduce or eliminate coverage as a result of
the requirements of this section.
   (i) 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 XIIIB 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 XIIIB of the California Constitution.