Diabetes Coverage RCW 48.46.272 Contract must provide appropriate and medically necessary Requirements (2)(a); equipment and supplies, as prescribed by a health care provider, for WAC all subscribers diagnosed “Insulin using”, “Non-insulin using”, and “elevated blood glucose induced by pregnancy. This must include: WAC insulin, syringes, injection aids, blood glucose monitors, test strips (for blood glucose monitors, visual blood sugar reading, and urine WAC testing); insulin pumps and accessories to the pumps, insulin infusion devices, prescriptive oral agents for controlling blood sugar levels, foot care appliances for prevention of complications associated with diabetes, and glucagon emergency kits. Diabetes Coverage RCW 48.46.272 Whether or not the contract provides Pharmacy Benefits, contract (Cont’d) Requirement (2)(b); WAC must provide: (Cont’d) outpatient self-management training and education, including medical nutrition therapy, as ordered by the health care provider. Diabetes outpatient self-management training and education may be provided only by providers with expertise in diabetes. HMO may restrict patients to seeing only health care providers who have signed participating provider agreements with the HMO or an insuring entity under contract with the HMO. RCW Benefits may be subject to customary cost sharing for all similar 48.46.272(3) services or supplies within the policy. 48.46.272(5) Services must be covered when deemed medically necessary. WAC Plan must provide routine foot care for diabetic persons. Disclosures List of RCW Issuer must provide to all enrollees and prospective enrollees a list of Disclosure 48.43.510(3) available disclosure items, including: Items WAC Instructions on how to access and request copies in paper and electronic forms, and
Diabetes Coverage Requirements RCW 48.46.272 (2)(a); WAC WAC WAC Contract must provide appropriate and medically necessary equipment and supplies, as prescribed by a health care provider, for all subscribers diagnosed “Insulin using”, “Non-insulin using”, and “elevated blood glucose induced by pregnancy. This must include: insulin, syringes, injection aids, blood glucose monitors, test strips (for blood glucose monitors, visual blood sugar reading, and urine testing); insulin pumps and accessories to the pumps, insulin infusion devices, prescriptive oral agents for controlling blood sugar levels, foot care appliances for prevention of complications associated with diabetes, and glucagon emergency kits. Diabetes (Cont’d) Coverage (Cont’d) RCW 48.46.272 (2)(b); WAC Whether or not the contract provides Pharmacy Benefits, contract must provide: outpatient self-management training and education, including medical nutrition therapy, as ordered by the health care provider. Diabetes outpatient self-management training and education may be provided only by providers with expertise in diabetes. HMO may restrict patients to seeing only health care providers who have signed participating provider agreements with the HMO or an insuring entity under contract with the HMO. RCW 48.46.272(3) Benefits may be subject to customary cost sharing for all similar services or supplies within the policy. 48.46.272(5) Services must be covered when deemed medically necessary. WAC Plan must provide routine foot care for diabetic persons. Disclosures List of Disclosure RCW 48.43.510(3) Issuer must provide to all enrollees and prospective enrollees a list of available disclosure items, including: Items WAC Instructions on how to access and request copies in paper and electronic forms, and Requirement
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