Md. Code Regs. 10.67.06.24

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.06.24 - Benefits - Diabetes Prevention and Care Services

A. An MCO shall provide to its qualifying enrollees medically necessary diabetes prevention and care services as specified in this regulation.

B. National Diabetes Prevention Program.

(1) In addition to the services included in its usual benefits package, an MCO shall make available to its enrollees who meet the Centers for Disease Control and Prevention (CDC) eligibility criteria defined in §B(2) of this regulation the National Diabetes Prevention Program through a CDC-recognized lifestyle change organization.

(2) To be eligible for participation in the National Diabetes Prevention Program, a HealthChoice enrollee:

(a) Shall be 18 through 64 years old;

(b) Shall be overweight or obese;

(c) Shall have an elevated blood glucose level or a history of gestational diabetes mellitus;

(d) May not have a previous diagnosis of type 1 or type 2 diabetes prior to enrollment; and

(e) May not be currently pregnant.

C. In addition to the services included in its usual benefits package, an MCO shall provide enrollees with a diabetes diagnosis the following medically necessary special diabetes-related services:

(1) Diabetes nutrition counseling, consisting of one initial one-on-one session and up to 4 subsequent sessions annually;

(2) Diabetes outpatient education;

(3) Diabetes-related durable medical equipment, disposable medical supplies, and therapeutic footwear and related services, when ordered as medically necessary, including:

(a) Therapeutic footwear, orthopedic shoes, arch supports, orthotic devices, in-shoe supports, elastic support, or examinations for prescription or fitting and related services to prevent or delay a foot amputation that would be highly probable in the absence of the specialized footwear;

(b) Blood glucose monitoring supplies;

(c) Diagnostic reagent strips and tablets used in testing for ketones and glucose in urine and glucose in blood;

(d) Finger-sticking devices used in obtaining blood samples for blood glucose testing; and

(e) Blood glucose reflectance meters for home use;

(4) Routine foot care; and

(5) Vision care consisting of:

(a) One ophthalmologic examination per year; and

(b) One pair of eyeglasses per year.

Md. Code Regs. 10.67.06.24

Regulations .24 recodified from 10.09.67.24 effective 46:22 Md. R. 976, eff. 11/1/2019