New laws taking effect in Maryland with the new year will require insurers to provide benefits for patients with certain health conditions, including high blood sugar levels that pose a risk for diabetes as well as a particular kind of chronic swelling.
One law taking effect Tuesday expands coverage for equipment, supplies and self-management training to apply to elevated or impaired glucose levels caused by prediabetes. That's a condition when blood sugar levels are elevated but not high enough to be diagnosed as diabetes. The new mandate also will apply to treating impaired glucose levels induced by pregnancy.
About 1.6 million adults in Maryland have prediabetes, according to the American Diabetes Association. It is usually treated with dietary changes, exercise and weight loss. The new law also allows reimbursement for services from a licensed dietitian or nutritionist for the treatment of prediabetes and obesity.
Another new law will require health insurers to cover treatment of a type of chronic swelling, often in an arm or leg, known as lymphedema. That's an abnormal collection of fluid just beneath the skin. It usually develops when lymph vessels are damaged or lymph nodes are removed. If left untreated, it can lead to chronic inflammation, infection and hardening of the skin that can result in further lymph vessel damage and distortion of the shape of affected body parts.
Several other states, including California, Massachusetts, North Carolina and Virginia, mandate health insurance coverage for lymphedema, according to an analysis of the law by the Maryland Department of Legislative Services. North Carolina and Virginia specifically mandate coverage for equipment, supplies and self-management training.
A December 2016 report prepared for the Maryland Health Care Commission found an estimated 7,400 fully insured people in the state had lymphedema in 2014. The report by NovaRest Inc. also found that the mandate would not have a material impact on utilization or the total cost of health care in Maryland.
While all insurance carriers provide coverage for lymphedema when medically necessary, coverage limits such as maximum allowable benefit or number of visits may apply.
Here's a look at some other new laws affecting health insurance coverage in Maryland:
A new law will require insurers to cover instruction by a licensed health care provider on “fertility awareness-based methods,” which are ways of identifying times of fertility and infertility to avoid pregnancy.
Health insurers will be required to cover fertility preservation procedures for people who need medical treatment that could directly or indirectly cause “iatrogenic infertility,” which is infertility caused by cancer treatments.
Local health departments
Insurers will be required to compensate local health departments that provide behavioral health services in parts of the state where local health departments are the only providers of behavioral health services.