<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><meta http-equiv='content-language' content='en-us'/><title>SDLRC - Codified Law 58-18B-56 - Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations. </title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s2075510Normal { margin-top: 0; margin-bottom: 0; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-left: 0; margin-right: 0; } span.s2075510SENU { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2075510CL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } p.s2075510Normal-000000 { margin-top: 0; margin-bottom: 0; text-indent: 0.50in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-left: 0; margin-right: 0; } span.s2075510DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s2075510DefaultParagraphFont-000001 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s2075510Normal-000002 { margin-top: 0; margin-bottom: 0; text-indent: 0.25in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-left: 0; margin-right: 0; } span.s2075510000003 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s2075510SCL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2075510SCL-000004 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } body { text-decoration-skip-ink: none; } </style></head><body><div><p dir="ltr" class="s2075510Normal"><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-18B-56"><span class="s2075510SENU">58-18B-56</span></a><span xml:space="preserve" class="s2075510SENU">. </span><span class="s2075510CL">Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.</span></p><p dir="ltr" class="s2075510Normal-000000"><span class="s2075510DefaultParagraphFont">Every small employer health benefit plan delivered, issued for delivery, or renewed in this state, except for policies that provide coverage for specified disease or other limited benefit coverage, shall provide, in writing, coverage for equipment, supplies, and self</span><span class="s2075510DefaultParagraphFont-000001">-</span><span class="s2075510DefaultParagraphFont">management training and education, including medical nutrition therapy, for treatment of persons diagnosed with diabetes if prescribed by a physician or other licensed health care provider legally authorized to prescribe such treatment. Medical nutrition therapy does not include any food items or nonprescription drugs.</span></p><p dir="ltr" class="s2075510Normal-000002"><span class="s2075510DefaultParagraphFont">Coverage for medically necessary equipment and supplies shall include blood glucose monitors, blood glucose monitors for the legally blind, test strips for glucose monitors, urine testing strips, insulin, injection aids, lancets, lancet devices, syringes, insulin pumps and all supplies for the pump, insulin infusion devices, prescribed oral agents for controlling blood sugars, glucose agents, glucagon kits, insulin measurement and administration aids for the visually impaired, and other medical devices for treatment of diabetes.</span></p><p dir="ltr" class="s2075510Normal-000002"><span class="s2075510DefaultParagraphFont">Diabetes self</span><span class="s2075510DefaultParagraphFont-000001">-</span><span class="s2075510DefaultParagraphFont">management training and education shall be covered if: (a) the service is provided by a physician, nurse, dietitian, pharmacist, or other licensed health care provider who satisfies the current academic eligibility requirements of the National Certification Board for Diabetic Educators and has completed a course in diabetes education and training or has been certified as a diabetes educator; and (b) the training and education is based upon a diabetes program recognized by the American Diabetes Association or a diabetes program with a curriculum approved by the American Diabetes Association or the South Dakota Department of Health.</span></p><p dir="ltr" class="s2075510Normal-000002"><span class="s2075510DefaultParagraphFont">Coverage of diabetes self</span><span class="s2075510DefaultParagraphFont-000001">-</span><span class="s2075510DefaultParagraphFont">management training is limited to (a) persons who are newly diagnosed with diabetes or have received no prior diabetes education; (b) persons who require a change in current therapy; (c) persons who have a co</span><span class="s2075510DefaultParagraphFont-000001">-</span><span class="s2075510DefaultParagraphFont">morbid condition such as heart disease or renal failure; or (d) persons whose diabetes condition is unstable. Under these circumstances, no more than two comprehensive education programs per lifetime and up to eight follow</span><span class="s2075510DefaultParagraphFont-000001">-</span><span class="s2075510DefaultParagraphFont">up visits per year need be covered. Coverage is limited to the closest available qualified education program that provides the necessary management training to accomplish the prescribed treatment.</span></p><p dir="ltr" class="s2075510Normal-000002"><span class="s2075510DefaultParagraphFont">The benefits provided in this section are subject to the same dollar limits, deductibles, coinsurance, and other restrictions established for all other benefits covered in the plan.</span></p><p dir="ltr" class="s2075510Normal"><span xml:space="preserve" class="s2075510000003"> </span></p><p dir="ltr" class="s2075510Normal"><span class="s2075510SCL">Source:</span><span xml:space="preserve" class="s2075510SCL-000004"> SL 1999, ch 252, § 5.</span></p></div></body></html>