SENATE BILL NO. 414


   March 4, 1999, Introduced by Senator SCHWARZ and referred to the
        Committee on Health Policy.



        A bill to amend 1984 PA 218, entitled

   "Third party administrator act,"

   (MCL 550.901 to 550.962) by adding section 33.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 33.  (1) A TPA SHALL NOT ENTER INTO A SERVICE CONTRACT

 2    TO ADMINISTER A PLAN UNLESS THE PLAN INCLUDES COVERAGE FOR THE

 3    FOLLOWING EQUIPMENT, SUPPLIES, AND EDUCATIONAL TRAINING FOR THE

 4    TREATMENT OF DIABETES, IF PRESCRIBED BY A PHYSICIAN:

 5         (A) BLOOD GLUCOSE MONITORS AND BLOOD GLUCOSE MONITORS FOR

 6    THE LEGALLY BLIND.

 7         (B) TEST STRIPS FOR GLUCOSE MONITORS AND VISUAL READING AND

 8    URINE TESTING STRIPS.

 9         (C) INSULIN.

10         (D) INJECTION AIDS.




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 1         (E) CARTRIDGES FOR THE LEGALLY BLIND.

 2         (F) SYRINGES.

 3         (G) INSULIN PUMPS AND APPURTENANCES THERETO.

 4         (H) INSULIN INFUSION DEVICES.

 5         (I) ORAL AGENTS FOR CONTROLLING BLOOD SUGAR IF FILLED BY A

 6    PHARMACIST.

 7         (J) DIABETES SELF-MANAGEMENT TRAINING TO ENSURE THAT PERSONS

 8    WITH DIABETES ARE TRAINED AS TO THE PROPER SELF-MANAGEMENT AND

 9    TREATMENT OF THEIR DIABETIC CONDITION, INCLUDING INFORMATION ON

10    MEDICAL NUTRITION THERAPY.  THIS COVERAGE FOR SELF-MANAGEMENT

11    TRAINING AND MEDICAL NUTRITION THERAPY TRAINING IS SUBJECT TO ALL

12    OF THE FOLLOWING:

13         (i) IS LIMITED TO 1 PHYSICIAN VISIT OR COMPLETION OF A
             CER-

14    TIFIED DIABETES EDUCATION PROGRAM UPON EACH OCCURRENCE OF ANY OF

15    THE FOLLOWING:

16         (A) IF CONSIDERED MEDICALLY NECESSARY UPON THE DIAGNOSIS OF

17    DIABETES.

18         (B) IF A PHYSICIAN DIAGNOSES A SIGNIFICANT CHANGE IN THE

19    PATIENT'S SYMPTOMS OR CONDITIONS THAT NECESSITATES CHANGES IN A

20    PATIENT'S SELF-MANAGEMENT OR A SIGNIFICANT CHANGE IN MEDICAL PRO-

21    TOCOL OR TREATMENT MODALITIES.

22         (C) IF REEDUCATION OR REFRESHER TRAINING IS NECESSARY AND IS

23    PRESCRIBED BY A PHYSICIAN.

24         (ii) MAY BE PROVIDED BY THE PHYSICIAN AS PART OF AN
             OFFICE

25    VISIT FOR DIABETES DIAGNOSIS OR TREATMENT.

26         (iii) MAY BE PROVIDED BY A DIABETES OUTPATIENT TRAINING

27    PROGRAM CERTIFIED BY THE DEPARTMENT OF COMMUNITY HEALTH.



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 1    TRAINING PROVIDED UNDER THIS SUBPARAGRAPH MAY BE LIMITED TO GROUP

 2    SETTINGS WHENEVER PRACTICABLE.

 3         (iv) INCLUDES HOME VISITS IF MEDICALLY NECESSARY.

 4         (2) AS USED IN THIS SECTION:

 5         (A) "DIABETES" INCLUDES ALL OF THE FOLLOWING:

 6         (i) GESTATIONAL DIABETES.

 7         (ii) INSULIN-USING DIABETES.

 8         (iii) NON-INSULIN-USING DIABETES.

 9         (B) "PHYSICIAN" MEANS AN ALLOPATHIC OR OSTEOPATHIC PHYSICIAN

10    OR PODIATRIST.




































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