Provides for individual, group and health maintenance organization coverage for glycated hemoglobin test for diabetes for up to four times per year when recommended or prescribed by a physician or other health care provider.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A3562
SPONSOR: O'Donnell (MS) TITLE OF BILL: An act to amend the insurance law, in relation to
medical coverage for certain diagnostic tests for diabetes
PURPOSE OR GENERAL IDEA OF BILL:
This bill would amend the Insurance law to require insurers to cover
glycated hemoglobin tests (also known as A1C tests) up to four times per
year if a doctor or other authorized health care provider prescribes or
recommends such testing.
SUMMARY OF SPECIFIC PROVISIONS:
Section one of the bill amends Insurance Law section 3216(i)(15-a)(A) to
add glycated hemoglobin (A1C) tests to the list of items for which
coverage is required. Existing law already requires coverage for various
equipment and supplies for the treatment of diabetes, if recommended or
prescribed by a physician or other licensed health care provider legally
authorized to prescribe. This bill adds A1C tests, for the treatment,
diagnosis and prevention of diabetes, to existing coverage requirements,
subject to the same conditions (i.e., recommendation or prescription by
a physician or licensed health care provider).
Sections two and three of the bill make similar changes to Insurance Law
sections 3221 (k)(7)(A) and 4303(u)(1), respectively.
JUSTIFICATION:
Diabetes has been widely recognized as a chronic disease that is reach-
ing epidemic proportions in the United States and that leads to compli-
cations that are both costly and life-impairing. Doctors use several
tests that measure blood glucose levels to diagnose diabetes. Two of
those tests (the fasting plasma glucose test and the 2-hour post-chal-
lenge plasma glucose test) measure short term glucose levels. A third
test, the glycated hemoglobin test, also known as the A1C test, measures
long term blood glucose control. The A1C test measures average blood
glucose levels over an approximately three month period, the life span
of a red blood cell. Unlike the first two tests, which measure blood
glucose levels at a particular point in time, the A1C test gives both
doctor and patient a sense of the patient's average blood glucose
control over the past three months and therefore a sense of how well the
patient's treatment plan is working. Thus, if a doctor wants to monitor
a patient's blood glucose levels and blood glucose control over time.
Not all insurance companies will cover multiple A1C tests within a
single year. Coverage varies, with some companies covering as many tests
as a doctor recommends as medically necessary and others providing less
coverage. Coverage also varies depending on the plan. At least one
insurance company will only pay for the A1C test once a year. That is
inadequate for someone who needs to monitor his or her average blood
glucose level over an extended time period. This bill would fill the gap
in coverage. It does so by adding A1C tests up to four times per year to
the list of items for which the Insurance Law already requires coverage
for diabetes treatment. The bill adds the words "diagnosis" and
"prevention" so that, if a doctor deems multiple A1C tests medically
necessary to monitor a patient in the pre-diabetes stage, where blood
glucose levels are above normal but still below the threshold diagnostic
for diabetes, coverage will be available for such testing. The American
Diabetes Association estimates that there are 57 million adults in the
United States with pre-diabetes; research indicates that patients who
take action to manage blood glucose while they have pre-diabetes may be
able to delay or prevent the onset of type 2 diabetes. Research also
indicates that some long-term physical damage may already by occurring
in the pre-diabetes state.
PRIOR LEGISLATIVE HISTORY:
A.4063 (2011-2012); A.3652 (2009-2010); A3497 (2007-08); A10931 (2006)
FISCAL IMPLICATIONS:
None to the state.
EFFECTIVE DATE:
This act shall take effect immediately and apply to all contracts or
renewal contracts entered into on or after January first next succeeding
the date on which it shall have become a law.
