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[IP] Michigan's Diabetes Cost Reduction Act
Well, for anyone interested, here it is. This part pertains to Non-profit
insurers such as BC/BS of Michigan, but it's pretty much the same wording
for Profit insurers as well:
550.1416b Establishment of program to prevent onset of clinical diabetes
required; report; coverages; "diabetes" defined.
(1) A health care corporation shall establish and provide to members and
participating providers a program to prevent the onset of clinical
diabetes. This program for participating providers shall emphasize best
practice guidelines to prevent the onset of clinical diabetes and to treat
diabetes, including, but not limited to, diet, lifestyle, physical exercise
and fitness, and early diagnosis and treatment.
(2) A health care corporation shall regularly measure the effectiveness of
a program provided pursuant to subsection (1) by regularly surveying group
and nongroup members covered by the certificate. Not later than 2 years
after the effective date of the amendatory act that added this section,
each health care corporation shall prepare a report containing the results
of the survey and shall provide a copy of the report to the department of
(3) A health care corporation certificate shall provide benefits in each
group and nongroup certificate for the following equipment, supplies, and
educational training for the treatment of diabetes, if determined to be
medically necessary and prescribed by an allopathic or osteopathic physician:
(a) Blood glucose monitors and blood glucose monitors for the legally blind.
(b) Test strips for glucose monitors, visual reading and urine testing
strips, lancets, and spring-powered lancet devices.
(e) Insulin pumps and medical supplies required for the use of an insulin
(f) Nonexperimental medication for controlling blood sugar.
(g) Diabetes self-management training to ensure that persons with diabetes
are trained as to the proper self-management and treatment of their
(4) A health care corporation certificate shall provide benefits in each
group and nongroup certificate for medically necessary medications
prescribed by an allopathic, osteopathic, or podiatric physician and used
in the treatment of foot ailments, infections, and other medical conditions
of the foot, ankle, or nails associated with diabetes.
(5) Coverage under subsection (3) for diabetes self-management training is
subject to all of the following:
(a) Is limited to completion of a certified diabetes education program upon
occurrence of either of the following:
(i) If considered medically necessary upon the diagnosis of diabetes by an
allopathic or osteopathic physician who is managing the patient's diabetic
condition and if the services are needed under a comprehensive plan of care
to ensure therapy compliance or to provide necessary skills and knowledge.
(ii) If an allopathic or osteopathic physician diagnoses a significant
change with long-term implications in the patient's symptoms or conditions
that necessitates changes in a patient's self-management or a significant
change in medical protocol or treatment modalities.
(b) Shall be provided by a diabetes outpatient training program certified
to receive medicare or medicaid reimbursement or certified by the
department of community health. Training provided under this subdivision
shall be conducted in group settings whenever practicable.
(6) Benefits under this section are not subject to dollar limits,
deductibles, or copayment provisions that are greater than those for
physical illness generally.
(7) As used in this section, "diabetes" includes all of the following:
(a) Gestational diabetes.
(b) Insulin-dependent diabetes.
(c) Non-insulin-dependent diabetes.
So, there it is... more than you ever wanted to know. ;o) I found links
for this near the bottom of the page
. This law went into effect March 28, 2001.
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