Requires health insurance plans to provide coverage for continuous blood glucose monitors for all children; requires coverage for glucose monitoring devices for all sugar disorders.
STATE OF NEW YORK
________________________________________________________________________
6923
2025-2026 Regular Sessions
IN ASSEMBLY
March 18, 2025
___________
Introduced by M. of A. WEPRIN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance plans to provide coverage for continuous blood glucose moni-
tors for all children
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (A) of paragraph 15-a of subsection (i) of
2 section 3216 of the insurance law, as amended by chapter 338 of the laws
3 of 2003, is amended to read as follows:
4 (A) Every policy which provides medical coverage that includes cover-
5 age for physician services in a physician's office and every policy
6 which provides major medical or similar comprehensive-type coverage
7 shall include coverage for the following equipment and supplies for the
8 treatment of diabetes and other sugar disorders, if recommended or
9 prescribed by a physician or other licensed health care provider legally
10 authorized to prescribe under title eight of the education law, regard-
11 less of the patient's age: blood glucose monitors and blood glucose
12 monitors for the visually impaired, continuous blood glucose monitors,
13 including but not limited to devices produced by Dexcom, data management
14 systems, test strips for glucose monitors and visual reading and urine
15 testing strips, insulin, injection aids, cartridges for the visually
16 impaired, syringes, insulin pumps and appurtenances thereto, insulin
17 infusion devices, and oral agents for controlling blood sugar. In addi-
18 tion, the commissioner of the department of health shall provide and
19 periodically update by rule or regulation a list of additional diabetes
20 equipment and related supplies such as are medically necessary for the
21 treatment of diabetes, for which there shall also be coverage. Such
22 policies shall also include coverage for diabetes self-management educa-
23 tion to ensure that persons with diabetes are educated as to the proper
24 self-management and treatment of their diabetic condition, including
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10846-01-5
A. 6923 2
1 information on proper diets. Such coverage for self-management education
2 and education relating to diet shall be limited to visits medically
3 necessary upon the diagnosis of diabetes, where a physician diagnoses a
4 significant change in the patient's symptoms or conditions which neces-
5 sitate changes in a patient's self-management, or where reeducation or
6 refresher education is necessary. Such education may be provided by the
7 physician or other licensed health care provider legally authorized to
8 prescribe under title eight of the education law, or their staff, as
9 part of an office visit for diabetes diagnosis or treatment, or by a
10 certified diabetes nurse educator, certified nutritionist, certified
11 dietitian or registered dietitian upon the referral of a physician or
12 other licensed health care provider legally authorized to prescribe
13 under title eight of the education law. Education provided by the certi-
14 fied diabetes nurse educator, certified nutritionist, certified dieti-
15 tian or registered dietitian may be limited to group settings wherever
16 practicable. Coverage for self-management education and education
17 relating to diet shall also include home visits when medically neces-
18 sary.
19 § 2. Subparagraph (A) of paragraph 7 of subsection (k) of section 3221
20 of the insurance law, as amended by chapter 338 of the laws of 2003, is
21 amended to read as follows:
22 (A) Every group or blanket accident and health insurance policy issued
23 or issued for delivery in this state which provides medical coverage
24 that includes coverage for physician services in a physician's office
25 and every policy which provides major medical or similar comprehensive-
26 type coverage shall include coverage for the following equipment and
27 supplies for the treatment of diabetes and other sugar disorders, if
28 recommended or prescribed by a physician or other licensed health care
29 provider legally authorized to prescribe under title eight of the educa-
30 tion law, regardless of the patient's age: blood glucose monitors and
31 blood glucose monitors for the visually impaired, continuous blood
32 glucose monitors, including but not limited to devices produced by
33 Dexcom, data management systems, test strips for glucose monitors and
34 visual reading and urine testing strips, insulin, injection aids,
35 cartridges for the visually impaired, syringes, insulin pumps and
36 appurtenances thereto, insulin infusion devices, and oral agents for
37 controlling blood sugar. In addition, the commissioner of the department
38 of health shall provide and periodically update by rule or regulation a
39 list of additional diabetes equipment and related supplies such as are
40 medically necessary for the treatment of diabetes, for which there shall
41 also be coverage. Such policies shall also include coverage for diabetes
42 self-management education to ensure that persons with diabetes are
43 educated as to the proper self-management and treatment of their diabet-
44 ic condition, including information on proper diets. Such coverage for
45 self-management education and education relating to diet shall be limit-
46 ed to visits medically necessary upon the diagnosis of diabetes, where a
47 physician diagnoses a significant change in the patient's symptoms or
48 conditions which necessitate changes in a patient's self-management, or
49 where reeducation or refresher education is necessary. Such education
50 may be provided by the physician or other licensed health care provider
51 legally authorized to prescribe under title eight of the education law,
52 or their staff, as part of an office visit for diabetes diagnosis or
53 treatment, or by a certified diabetes nurse educator, certified nutri-
54 tionist, certified dietitian or registered dietitian upon the referral
55 of a physician or other licensed health care provider legally authorized
56 to prescribe under title eight of the education law. Education provided
A. 6923 3
1 by the certified diabetes nurse educator, certified nutritionist, certi-
2 fied dietitian or registered dietitian may be limited to group settings
3 wherever practicable. Coverage for self-management education and educa-
4 tion relating to diet shall also include home visits when medically
5 necessary.
6 § 3. Paragraph 1 of subsection (u) of section 4303 of the insurance
7 law, as amended by chapter 338 of the laws of 2003, is amended to read
8 as follows:
9 (1) A medical expense indemnity corporation or a health service corpo-
10 ration which provides medical coverage that includes coverage for physi-
11 cian services in a physician's office and every policy which provides
12 major medical or similar comprehensive-type coverage shall include
13 coverage for the following equipment and supplies for the treatment of
14 diabetes and other sugar disorders, if recommended or prescribed by a
15 physician or other licensed health care provider legally authorized to
16 prescribe under title eight of the education law, regardless of the
17 patient's age: blood glucose monitors and blood glucose monitors for
18 the visually impaired, continuous blood glucose monitors, including but
19 not limited to devices produced by Dexcom, data management systems, test
20 strips for glucose monitors and visual reading and urine testing strips,
21 insulin, injection aids, cartridges for the visually impaired, syringes,
22 insulin pumps and appurtenances thereto, insulin infusion devices, and
23 oral agents for controlling blood sugar. In addition, the commissioner
24 of the department of health shall provide and periodically update by
25 rule or regulation a list of additional diabetes equipment and related
26 supplies such as are medically necessary for the treatment of diabetes,
27 for which there shall also be coverage. Such policies shall also include
28 coverage for diabetes self-management education to ensure that persons
29 with diabetes are educated as to the proper self-management and treat-
30 ment of their diabetic condition, including information on proper diets.
31 Such coverage for self-management education and education relating to
32 diet shall be limited to visits medically necessary upon the diagnosis
33 of diabetes, where a physician diagnoses a significant change in the
34 patient's symptoms or conditions which necessitate changes in a
35 patient's self-management, or where reeducation or refresher education
36 is necessary. Such education may be provided by the physician or other
37 licensed health care provider legally authorized to prescribe under
38 title eight of the education law, or their staff, as part of an office
39 visit for diabetes diagnosis or treatment, or by a certified diabetes
40 nurse educator, certified nutritionist, certified dietitian or regis-
41 tered dietitian upon the referral of a physician or other licensed
42 health care provider legally authorized to prescribe under title eight
43 of the education law. Education provided by the certified diabetes nurse
44 educator, certified nutritionist, certified dietitian or registered
45 dietitian may be limited to group settings wherever practicable. Cover-
46 age for self-management education and education relating to diet shall
47 also include home visits when medically necessary.
48 § 4. This act shall take effect on the ninetieth day after it shall
49 have become a law, and shall apply to policies and contracts issued,
50 renewed, amended, modified or altered on or after such date.
