<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".24" citation="COMAR 10.67.06.24" title_num="10" subtitle_num="67" chapter_num="06" heading="Benefits — Diabetes Prevention and Care Services.">
  <paragraph num="A.">
    <text>An MCO shall provide to its qualifying enrollees medically necessary diabetes prevention and care services as specified in this regulation.</text>
  </paragraph>
  <paragraph num="B.">
    <text>National Diabetes Prevention Program.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To be eligible for participation in the National Diabetes Prevention Program, a HealthChoice enrollee:</text>
      <paragraph num="(a)">
        <text>Shall be 18 through 64 years old;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Shall be overweight or obese;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Shall have an elevated blood glucose level or a history of gestational diabetes mellitus;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>May not have a previous diagnosis of type 1 or type 2 diabetes prior to enrollment; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>May not be currently pregnant.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Diabetes nutrition counseling, consisting of one initial one-on-one session and up to 4 subsequent sessions annually;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Diabetes outpatient education;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Diabetes-related durable medical equipment, disposable medical supplies, and therapeutic footwear and related services, when ordered as medically necessary, including:</text>
      <paragraph num="(a)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Blood glucose monitoring supplies;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Diagnostic reagent strips and tablets used in testing for ketones and glucose in urine and glucose in blood;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Finger-sticking devices used in obtaining blood samples for blood glucose testing; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Blood glucose reflectance meters for home use;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Routine foot care; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Vision care consisting of:</text>
      <paragraph num="(a)">
        <text>One ophthalmologic examination per year; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>One pair of eyeglasses per year.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>