Fla. Admin. Code Ann. R. 69O-191.037 - Mandatory Coverage of Diabetes Treatment
(1) Section
641.31(26)(a),
F.S., prohibits the application of monetary limitations to limit coverage of
medically appropriate and necessary equipment, supplies, and services used to
treat diabetes, if the patient's primary care physician or physician
specializing in diabetes to whom the patient has been referred certifies that
the equipment, supplies, or services are necessary.
(2) The term "appropriate" as used in this
rule excludes unproven technology, such as experimental treatment or non-FDA
approved treatment.
(3) Coverage
for equipment meeting the standard in Section
641.31(26)(a),
F.S., shall not be limited by monetary limitations for durable medical
equipment or other limitations in a health maintenance organization or prepaid
health plan contract.
(4) Section
641.31(26)(a),
F.S., does not prohibit the application of deductibles or copayments to
equipment, supplies, and services meeting the criteria in that
paragraph.
(5) Payments for
equipment meeting the standard in Section
641.31(26)(a),
F.S., can be used by an HMO to apply toward limits for durable medical
equipment which does not meet that standard.
(6) Nothing in this rule shall prohibit a
health maintenance organization or prepaid health plan from utilizing contract
providers for equipment, supplies, and services certified as necessary by the
patient's primary care physician or the physician to whom the patient has been
referred who specializes in treating diabetes, if such equipment, supplies and
services are available from the contract provider.
Notes
Rulemaking Authority 624.308, 641.36 FS. Law Implemented 624.307(1), 641.31(26)(a) FS.
New 7-31-02, Formerly 4-191.037.
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