Health care coverage: diabetes-related complications.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires specified health care service plan contracts and health insurance policies to provide coverage for certain equipment, supplies, and medications for the treatment of diabetes, including podiatric devices to prevent or treat diabetes-related complications. Existing law also requires a plan or insurer to provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee or insured to properly use the equipment, supplies, and medications. This bill would require health care service plan contracts and health insurance policies to also provide coverage for the diagnosis and treatment of diabetes-related complications, as defined. Because a willful violation of this requirement by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.