Islets of Hope state diabetes insurance coverage laws

Information for this article was compiled and edited by Lahle A. Wolfe, Islets of Hope.

Important Disclaimer

This information for general information purposes only.  

It is not intended to be used a recommendation or endorse- ment of any program or entity

This information is not intended to serve as any form of medical or legal advice.

Article Sources

National Conference of State Legislatures

Government Accountability Office (GAO) report number GAO-05-210 entitled "Managing Diabetes: Health Plan Coverage of Services and Supplies;" released on March 28, 2005.

Federal Laws Pertaining to Persons with Diabetes

Diabetes Assistance Programs

Maine - State Diabetes Insurance Coverage Laws

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Maine has state-mandated laws that require individual and group insurance carriers (including HMOs) to cover diabetes care and education services.

Tit 24 § 2332-F (nonprofits); 2654 (individual) and 2847-E (group) - 1996 law.  Covers medically appropriate and necessary equipment, insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and out-patient self-management.

Summary of Provisions

• Requirement related to diabetes?  Yes
• Diabetes Education services covered?  Yes
• Medical nutritional therapy covered?  No
• Diabetes supplies covered?  Yes
• Specified supplies covered?  Yes

Reimbursement of Diabetes Self-Management Education and Supplies in Maine

According to the state of Main government website:

Public Law 592 (P.L. 592):

Effective July 4, 1996, Maine law P.L. 592 requires that health insurance policies in the state cover the following:

• Supplies
• Insulin
• Oral hypoglycemic agents
• Blood glucose monitors
• Test strips, lancets, and syringes
• Diabetes Self-Management Training and Education
• The Ambulatory Diabetes Education & Follow-Up (ADEF) Diabetes Self-Management Training (DSMT) Program authorized by the state’s Diabetes Prevention & Control Program (DPCP) within DHHS’s Maine Centers for Disease Control and Prevention. Some exceptions apply (ie. self-insured businesses)

Supplies and Self-Management Training and Education must be certified necessary by your doctor. This law does not change current Medicare and Maine Care Program coverage. Call 1 (800) 273-7147 or 287-5380 for more information.

Maine Diabetes Control Project - The program includes diabetes surveillance and evaluation activities; professional education; community interventions; technical assistance and resource support; promotion and advocacy of diabetes management standards of care; and, health insurance coverage for appropriate diabetes medical care, diabetic supplies and education.

Main Insurance Bulletin 258:  Mandate — Diabetes (Ch. 592) (07/04/96) -  All individual and group policies (including HMO's), except accident only, specified disease, or hospital indemnity policies must provide coverage for the treatment of diabetes, including equipment, supplies and education. Education must be through ambulatory diabetes facilities authorized by the Diabetes Control Project.

Maine Diabetes Prevention and Control Program

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Page Updated  03/09/2007