Bill Text: NY A10406 | 2011-2012 | General Assembly | Introduced
Bill Title: Establishes diabetes prevention demonstration programs.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-05-25 - referred to health [A10406 Detail]
Download: New_York-2011-A10406-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
10406
I N A S S E M B L Y
May 25, 2012
___________
Introduced by M. of A. PEOPLES-STOKES -- read once and referred to the
Committee on Health
AN ACT to amend the public health law and the insurance law, in relation
to establishing diabetes prevention demonstration programs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Article 2 of the public health law is amended by adding a
2 new title 4-A to read as follows:
3 TITLE IV-A
4 DIABETES PREVENTION DEMONSTRATION PROGRAMS
5 SECTION 255. DIABETES PREVENTION DEMONSTRATION PROGRAMS; ESTABLISHMENT.
6 S 255. DIABETES PREVENTION DEMONSTRATION PROGRAMS; ESTABLISHMENT. 1.
7 THE DEPARTMENT MAY ESTABLISH DIABETES PREVENTION DEMONSTRATION PROGRAMS
8 THROUGH A REQUEST FOR PROPOSALS PROCESS TO ENHANCE THE QUALITY AND
9 COST-EFFECTIVENESS OF CARE RENDERED TO MEDICAID-ELIGIBLE PERSONS WITH
10 PRE-DIABETES WHO MAY BE AT RISK FOR DIABETES WHICH CAN RESULT IN THE
11 NEED FOR CARE AND TREATMENT THAT RESULTS IN HIGH MEDICAID EXPENDITURES.
12 2. IN ORDER TO BE ELIGIBLE TO SPONSOR AND TO UNDERTAKE A DIABETES
13 PREVENTION DEMONSTRATION PROGRAM, THE PROPOSED SPONSOR SHALL BE A
14 NOT-FOR-PROFIT ORGANIZATION WITH A PROGRAM PROVIDING PATIENT EDUCATION
15 ON PHYSICAL ACTIVITY AND DIET USING EVIDENCE-BASED SERVICES THAT HAS
16 EXPERIENCE PROVIDING COST-EFFECTIVE COMMUNITY-BASED DIABETES PREVENTION
17 CARE TO SUCH PATIENTS WITH PRE-DIABETES.
18 3. THE DEPARTMENT SHALL APPROVE DIABETES PREVENTION DEMONSTRATION
19 PROGRAMS WHICH ARE GEOGRAPHICALLY DIVERSE AND REPRESENTATIVE OF BOTH
20 URBAN AND RURAL SOCIAL SERVICES DISTRICTS. THE PROGRAM SPONSOR MUST
21 ESTABLISH, TO THE SATISFACTION OF THE DEPARTMENT, ITS CAPACITY TO ENROLL
22 AND SERVE SUFFICIENT NUMBERS OF ENROLLEES TO DEMONSTRATE THE COST-EFFEC-
23 TIVENESS OF THE DEMONSTRATION PROGRAM.
24 4. THE DEPARTMENT SHALL ESTABLISH THE CRITERIA, INCLUDING THE DIAGNO-
25 SIS OF PRE-DIABETES AS MAY BE SPECIFIED BY THE DEPARTMENT, BY WHICH
26 INDIVIDUALS WILL BE IDENTIFIED AS ELIGIBLE FOR ENROLLMENT IN THE DEMON-
27 STRATION PROGRAMS. PERSONS ELIGIBLE FOR ENROLLMENT IN THE DEMONSTRATION
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15790-03-2
A. 10406 2
1 PROGRAMS SHALL BE LIMITED TO INDIVIDUALS WHO RECEIVE MEDICAL ASSISTANCE
2 PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
3 5. ENROLLMENT IN A DEMONSTRATION PROGRAM SHALL BE VOLUNTARY. A PARTIC-
4 IPATING INDIVIDUAL MAY DISCONTINUE HIS OR HER ENROLLMENT AT ANY TIME
5 WITHOUT CAUSE. THE COMMISSIONER SHALL REVIEW AND APPROVE ALL ENROLLMENT
6 AND MARKETING MATERIALS FOR A DEMONSTRATION PROGRAM.
7 6. THE DEMONSTRATION PROGRAM SHALL OFFER EVIDENCE-BASED SERVICES AND
8 INTERVENTIONS DESIGNED TO ENSURE THAT THE ENROLLEES RECEIVE HIGH QUALI-
9 TY, PREVENTATIVE AND COST-EFFECTIVE CARE, AIMED AT REDUCING THE DEVELOP-
10 MENT OF DIABETES. THE DEMONSTRATION PROGRAM MAY INCLUDE SCREENING OF
11 ELIGIBLE ENROLLEES, DEVELOPING AN INDIVIDUALIZED CARE MANAGEMENT PLAN
12 FOR EACH ENROLLEE AND IMPLEMENTING THAT PLAN.
13 7. THE DEPARTMENT SHALL BE RESPONSIBLE FOR MONITORING THE QUALITY,
14 APPROPRIATENESS AND COST-EFFECTIVENESS OF A DEMONSTRATION PROGRAM. THE
15 DEPARTMENT SHALL UTILIZE, TO THE EXTENT POSSIBLE, ALL POTENTIAL SOURCES
16 OF FUNDING FOR DEMONSTRATION PROGRAMS, INCLUDING, BUT LIMITED TO,
17 PRIVATE PAYMENTS AND DONATIONS. ALL SUCH FUNDS SHALL BE DEPOSITED BY THE
18 COMMISSIONER AND CREDITED TO THE DIABETES PREVENTION ACCOUNT WHICH SHALL
19 BE ESTABLISHED BY THE COMPTROLLER IN THE SPECIAL REVENUE-OTHER FUND.
20 ADDITIONALLY, TO THE EXTENT OF FUNDS APPROPRIATED THEREFOR, MEDICAL
21 ASSISTANCE FUNDS, INCLUDING ANY FUNDING OR SHARED SAVINGS AS MAY BECOME
22 AVAILABLE THROUGH FEDERAL WAIVERS OR OTHERWISE UNDER TITLES 18 AND 19 OF
23 THE FEDERAL SOCIAL SECURITY ACT, MAY BE USED BY THE DEPARTMENT FOR
24 EXPENDITURES IN SUPPORT OF THE DIABETES PREVENTION PROGRAM.
25 8. PAYMENTS SHALL BE MADE BY THE DEPARTMENT TO THE ENTITY RESPONSIBLE
26 FOR THE OPERATION OF THE DEMONSTRATION PROGRAM ON A FIXED AMOUNT PER
27 MEMBER PER LENGTH OF THE PROGRAM AND SHALL REIMBURSE THE PROGRAM SPON-
28 SOR FOR THE SERVICES RENDERED PURSUANT TO SUBDIVISION SIX OF THIS
29 SECTION. THE DEPARTMENT SHALL PROVIDE AN INTERIM REPORT TO THE GOVERNOR
30 AND THE LEGISLATURE ON OR BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND
31 THIRTEEN AND A FINAL REPORT ON OR BEFORE DECEMBER THIRTY-FIRST, TWO
32 THOUSAND FOURTEEN ON THE RESULTS OF THE DEMONSTRATION PROGRAMS. BOTH
33 REPORTS SHALL INCLUDE FINDINGS AS TO THE DEMONSTRATION PROGRAMS'
34 COST-EFFECTIVENESS IN PREVENTING THE DEVELOPMENT OF DIABETES AND ASSOCI-
35 ATED COMPLICATIONS. IN THE FINAL REPORT, THE DEPARTMENT SHALL OFFER
36 RECOMMENDATIONS AS TO WHETHER DEMONSTRATION PROGRAMS SHOULD BE EXTENDED,
37 MODIFIED, ELIMINATED OR MADE PERMANENT.
38 S 2. Subparagraph (A) of paragraph 15-a of subsection (i) of section
39 3216 of the insurance law, as amended and such paragraph as renumbered
40 by chapter 338 of the laws of 2003, is amended to read as follows:
41 (A) Every policy which provides medical coverage that includes cover-
42 age for physician services in a physician's office and every policy
43 which provides major medical or similar comprehensive-type coverage
44 shall include coverage for the following equipment and supplies for the
45 treatment of diabetes, if recommended or prescribed by a physician or
46 other licensed health care provider legally authorized to prescribe
47 under title eight of the education law: blood glucose monitors and blood
48 glucose monitors for the visually impaired, data management systems,
49 test strips for glucose monitors and visual reading and urine testing
50 strips, insulin, injection aids, cartridges for the visually impaired,
51 syringes, insulin pumps and appurtenances thereto, insulin infusion
52 devices, and oral agents for controlling blood sugar. In addition, the
53 commissioner of the department of health shall provide and periodically
54 update by rule or regulation a list of additional diabetes equipment and
55 related supplies such as are medically necessary for the treatment of
56 diabetes, for which there shall also be coverage. Such policies shall
A. 10406 3
1 also include coverage for diabetes self-management education to ensure
2 that persons with diabetes are educated as to the proper self-management
3 and treatment of their diabetic condition, including information on
4 proper diets. Such coverage for self-management education and education
5 relating to diet shall be limited to visits medically necessary upon the
6 diagnosis of diabetes, where a physician diagnoses a significant change
7 in the patient's symptoms or conditions which necessitate changes in a
8 patient's self-management, or where reeducation or refresher education
9 is necessary. Such education may be provided by the physician or other
10 licensed health care provider legally authorized to prescribe under
11 title eight of the education law, or their staff, as part of an office
12 visit for diabetes diagnosis or treatment, or by a certified diabetes
13 nurse educator, certified nutritionist, certified dietitian or regis-
14 tered dietitian upon the referral of a physician or other licensed
15 health care provider legally authorized to prescribe under title eight
16 of the education law. Education provided by the certified diabetes nurse
17 educator, certified nutritionist, certified dietitian or registered
18 dietitian may be limited to group settings wherever practicable. Cover-
19 age for self-management education and education relating to diet shall
20 also include home visits when medically necessary. IN ADDITION, UPON
21 RECOMMENDATION OF A PHYSICIAN SUCH POLICES SHALL INCLUDE COVERAGE FOR
22 DIABETES PREVENTION SERVICES TO PERSONS WITH PRE-DIABETES DIAGNOSED BY A
23 PHYSICIAN. SUCH SERVICES SHALL INCLUDE, BUT NOT BE LIMITED TO, PATIENT
24 EDUCATION ON PHYSICAL ACTIVITY AND DIET USING EVIDENCE-BASED SERVICES.
25 SUCH COVERAGE FOR DIABETES PREVENTION SERVICES MAY BE LIMITED TO
26 PROGRAMS THAT HAVE EXPERIENCE PROVIDING COST-EFFECTIVE COMMUNITY-BASED
27 DIABETES PREVENTION SERVICES, AND GROUP SETTINGS WHEREVER PRACTICABLE.
28 S 3. Subparagraph (A) of paragraph 7 of subsection (k) of section 3221
29 of the insurance law, as amended by chapter 338 of the laws of 2003, is
30 amended to read as follows:
31 (A) Every group or blanket accident and health insurance policy issued
32 or issued for delivery in this state which provides medical coverage
33 that includes coverage for physician services in a physician's office
34 and every policy which provides major medical or similar comprehensive-
35 type coverage shall include coverage for the following equipment and
36 supplies for the treatment of diabetes, if recommended or prescribed by
37 a physician or other licensed health care provider legally authorized to
38 prescribe under title eight of the education law: blood glucose monitors
39 and blood glucose monitors for the visually impaired, data management
40 systems, test strips for glucose monitors and visual reading and urine
41 testing strips, insulin, injection aids, cartridges for the visually
42 impaired, syringes, insulin pumps and appurtenances thereto, insulin
43 infusion devices, and oral agents for controlling blood sugar. In addi-
44 tion, the commissioner of the department of health shall provide and
45 periodically update by rule or regulation a list of additional diabetes
46 equipment and related supplies such as are medically necessary for the
47 treatment of diabetes, for which there shall also be coverage. Such
48 policies shall also include coverage for diabetes self-management educa-
49 tion to ensure that persons with diabetes are educated as to the proper
50 self-management and treatment of their diabetic condition, including
51 information on proper diets. Such coverage for self-management education
52 and education relating to diet shall be limited to visits medically
53 necessary upon the diagnosis of diabetes, where a physician diagnoses a
54 significant change in the patient's symptoms or conditions which neces-
55 sitate changes in a patient's self-management, or where reeducation or
56 refresher education is necessary. Such education may be provided by the
A. 10406 4
1 physician or other licensed health care provider legally authorized to
2 prescribe under title eight of the education law, or their staff, as
3 part of an office visit for diabetes diagnosis or treatment, or by a
4 certified diabetes nurse educator, certified nutritionist, certified
5 dietitian or registered dietitian upon the referral of a physician or
6 other licensed health care provider legally authorized to prescribe
7 under title eight of the education law. Education provided by the certi-
8 fied diabetes nurse educator, certified nutritionist, certified dieti-
9 tian or registered dietitian may be limited to group settings wherever
10 practicable. Coverage for self-management education and education
11 relating to diet shall also include home visits when medically neces-
12 sary. IN ADDITION, UPON RECOMMENDATION OF A PHYSICIAN SUCH POLICIES
13 SHALL INCLUDE COVERAGE FOR DIABETES PREVENTION SERVICES TO PERSONS WITH
14 PRE-DIABETES DIAGNOSED BY A PHYSICIAN. SUCH SERVICES SHALL INCLUDE, BUT
15 NOT BE LIMITED TO, PATIENT EDUCATION ON PHYSICAL ACTIVITY AND DIET USING
16 EVIDENCE-BASED SERVICES. SUCH COVERAGE FOR DIABETES PREVENTION SERVICES
17 MAY BE LIMITED TO PROGRAMS THAT HAVE EXPERIENCE PROVIDING COST-EFFECTIVE
18 COMMUNITY-BASED DIABETES PREVENTION SERVICES, AND GROUP SETTINGS WHEREV-
19 ER PRACTICABLE.
20 S 4. Paragraph 1 of subsection (u) of section 4303 of the insurance
21 law, as amended by chapter 338 of the laws of 2003, is amended to read
22 as follows:
23 (1) A medical expense indemnity corporation or a health service corpo-
24 ration which provides medical coverage that includes coverage for physi-
25 cian services in a physician's office and every policy which provides
26 major medical or similar comprehensive-type coverage shall include
27 coverage for the following equipment and supplies for the treatment of
28 diabetes, if recommended or prescribed by a physician or other licensed
29 health care provider legally authorized to prescribe under title eight
30 of the education law: blood glucose monitors and blood glucose monitors
31 for the visually impaired, data management systems, test strips for
32 glucose monitors and visual reading and urine testing strips, insulin,
33 injection aids, cartridges for the visually impaired, syringes, insulin
34 pumps and appurtenances thereto, insulin infusion devices, and oral
35 agents for controlling blood sugar. In addition, the commissioner of the
36 department of health shall provide and periodically update by rule or
37 regulation a list of additional diabetes equipment and related supplies
38 such as are medically necessary for the treatment of diabetes, for which
39 there shall also be coverage. Such policies shall also include coverage
40 for diabetes self-management education to ensure that persons with
41 diabetes are educated as to the proper self-management and treatment of
42 their diabetic condition, including information on proper diets. Such
43 coverage for self-management education and education relating to diet
44 shall be limited to visits medically necessary upon the diagnosis of
45 diabetes, where a physician diagnoses a significant change in the
46 patient's symptoms or conditions which necessitate changes in a
47 patient's self-management, or where reeducation or refresher education
48 is necessary. Such education may be provided by the physician or other
49 licensed health care provider legally authorized to prescribe under
50 title eight of the education law, or their staff, as part of an office
51 visit for diabetes diagnosis or treatment, or by a certified diabetes
52 nurse educator, certified nutritionist, certified dietitian or regis-
53 tered dietitian upon the referral of a physician or other licensed
54 health care provider legally authorized to prescribe under title eight
55 of the education law. Education provided by the certified diabetes nurse
56 educator, certified nutritionist, certified dietitian or registered
A. 10406 5
1 dietitian may be limited to group settings wherever practicable. Cover-
2 age for self-management education and education relating to diet shall
3 also include home visits when medically necessary. IN ADDITION, UPON
4 RECOMMENDATION OF A PHYSICIAN SUCH POLICES SHALL INCLUDE COVERAGE FOR
5 DIABETES PREVENTION SERVICES TO PERSONS WITH PRE-DIABETES DIAGNOSED BY A
6 PHYSICIAN. SUCH SERVICES SHALL INCLUDE, BUT NOT BE LIMITED TO, PATIENT
7 EDUCATION ON PHYSICAL ACTIVITY AND DIET USING EVIDENCE-BASED SERVICES.
8 SUCH COVERAGE FOR DIABETES PREVENTION SERVICES MAY BE LIMITED TO
9 PROGRAMS THAT HAVE EXPERIENCE PROVIDING COST-EFFECTIVE COMMUNITY-BASED
10 DIABETES PREVENTION SERVICES, AND GROUP SETTINGS WHEREVER PRACTICABLE.
11 S 5. This act shall take effect on the one hundred eightieth day after
12 it shall have become a law.
