ATS S.B. 982 76(R)    BILL ANALYSIS


Office of House Bill AnalysisS.B. 982
By: Madla
Insurance
4/26/1999
Engrossed




BACKGROUND AND PURPOSE 

It is estimated that more than 1.7 million Texans suffer from diabetes.  It
is also estimated that the probable annual cost of diabetes in Texas is $4
billion.  Most forms of diabetes can be managed properly with diet and
exercise or a combination of diet management, exercise, and
glucose-lowering medication.  A component of the 1997 legislation that
requires health benefit plans to provide certain benefits for diabetics is
the mandate that diabetics be provided self-management training.  The law
specifies that diabetes self-management training must be provided by a
health care practitioner or provider who is licensed, registered, or
certified in Texas to provide appropriate health care services. As defined,
self-management training includes training provided to a qualified insured
after the initial diagnosis of diabetes in the care and management of that
condition, including nutritional counseling and proper use of diabetes
equipment and supplies.  

Granted rulemaking authority to implement the law, the commissioner of
insurance has proposed that the self-management training program be
provided only by a diabetic educator certified by the American Association
of Diabetic Educators or a team of health professionals directed or
coordinated by a certified diabetic educator.  A certified diabetic
educator is a health professional, including a physician, registered nurse,
dietitian, pharmacist or other professional, who has mastered the core of
knowledge and skill in the biological and social sciences, communication
and counseling, 
and education, and who has experience in the care of patients with
diabetes.  If the self-management training programs are provided only by
diabetic educators certified by the American Association of Diabetic
Educators, there may be too few educators in relation to the number of
diabetics that need self-management training.  The result could be reduced
access to training and increased costs. 

S.B. 982 sets forth that a licensed, registered, or certified health care
practitioner or provider who provides diabetes self-management training
(training) must do so acting within the scope of practice authorized by the
practitioner's or provider's license, registration, or certification.
Those practitioners and providers include a licensed dietitian, a licensed
pharmacist, a licensed physician, a licensed physician assistant, a
licensed registered nurse, a licensed advance practice nurse, and a
Certified Diabetes Educator certified by the National Certification Board
for Diabetes Educators, among others. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the appropriate licensing board of
practitioners or providers authorized to provide diabetes self-management
training in SECTION 1 (Section 4, Article 21.53G, Insurance Code) of this
bill.  

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 4, Article 21.53G, Insurance Code, as follows:

Sec. 4.  DIABETES SELF-MANAGEMENT TRAINING.  (a) Sets forth that a
licensed, registered, or certified health care practitioner or provider who
provides diabetes selfmanagement training (training) must do so acting
within the scope of practice authorized by the license, registration, or
certification of the practitioner or provider. 

 (b) Adds this subsection to require a health benefit plan to provide
training or coverage for training for which a physician or practitioner has
written an order to each insured or the caretaker of the insured from: 

  _a training program recognized by the American Diabetes Association;

  _a multidisciplinary team, coordinated by a diabetes educator who is
certified by the National Certification Board for Diabetes Educators or a
person who has completed at least 24 hours of approved continuing education
that includes a combination of diabetes education, educational principles,
and behavioral strategies, consisting of at least a dietitian and a nurse
educator who collaborate routinely and which may include a pharmacist and a
social worker, and each member of which, other than a social worker, must
have recent didactic and experiential preparation in diabetes clinical and
educational issues; 

  _a Certified Diabetes Educator certified by the National Certification
Board for Diabetes Educators; 

  _a licensed health care practitioner, including a physician, a physician
assistant, a registered nurse, a licensed dietician, or a pharmacist, who
has recent didactic and experiential preparation in diabetes clinical and
educational issues; 

  _a licensed dietitian;

  _a licensed pharmacist;

  _a licensed physician;

  _a licensed physician assistant;

  _a licensed registered nurse; or

  _a licensed advance practice nurse.
 

(c) Adds this subsection to define "nutritional counseling."

(d) Requires the appropriate licensing board of practitioners or providers
authorized to provide diabetes self-management training, in consultation
with the Texas Diabetes Council, by rule, to determine the recent didactic
and experiential preparation in diabetes clinical and educational issues to
qualify licensees of the board to provide the training, and, by rule, to
determine and define the component or components of diabetes
self-management training. 

SECTION 2.Effective date: September 1, 1999.
Makes application of this Act prospective a health benefit plan that is
delivered, issued for delivery, or renewed on or after January 1, 2000. 

SECTION 3.Emergency clause.