BG S.B. 162 75(R)BILL ANALYSIS PUBLIC HEALTH S.B. 162 By: Barrientos (Raymond) 3-19-97 Committee Report (Unamended) BACKGROUND Currently, Texas does not have a program dedicated to the prevention and treatment of diabetes. Diabetes is the sixth leading cause of death in Texas. According to the Texas Department of Health (TDH), more than 865,000 Texans have diabetes, and experts believe that twice as many cases may exist undetected. Studies show that the disease disproportionally affects Hispanics, African Americans, women, and older people. The disease results from the body's inability to produce insulin, a reduction in the biological effectiveness of insulin, or both. Insulin is a hormone that aids the body in regulating sugar use and storage in the body and allows sugar to enter the cells to provide energy. Diabetics run a higher risk of heart attack, stroke, high blood pressure, nerve disease, kidney failure, blindness and circulatory problems. Diabetes disproportionally strikes Hispanics, African Americans, women, and the elderly. Diabetes costs Texans approximately $4 billion in 1992 in direct and indirect medical costs of lost productivity, according to a report prepared by the LBJ School of Public Affairs for the Texas Diabetes Council. The cost to the state, including its share of Medicaid, was $52 million. Of that amount, TDH, the Texas Rehabilitation Commission, and the Texas Commission for the Blind spent $18.3 million on diabetes-related programs. Maryland received a Medicaid waiver in 1991 to establish a diabetes care program as a managed care model. The goal was to reduce the number of hospital admissions through improved prevention. A trial program during 1993 and 1994 resulted in a 40 percent decreased risk of hospital admission for enrollees the first year, and a 50 percent reduction the second year. The program promoted nutrition counseling, case management and structured outpatient diabetes education programs, which are services not normally provided by Medicaid. PURPOSE S.B. 162 provides for the development and implementation of a diabetes care program in selected counties with a high incidence of diabetes and diabetes death rates. This bill also provides for the education of the public about diabetes. RULEMAKING AUTHORITY It is the committee's opinion that this bill expressly grants additional rulemaking authority to the Health and Human Services Commission (HHSC) in ARTICLE 1, SECTION 1.02 (a) and to the Commissioner of the Texas Department of Insurance in ARTICLE 2, Section 2.01 (Art. 21.53D, Sec. 3(a), Insurance Code) of this bill. SECTION BY SECTION ANALYSIS ARTICLE 1. TEXAS DIABETES CARE PILOT PROGRAM. SECTION 1.01. Defines commission, council, and program. SECTION 1.02. Subsection (a) requires that HHSC develop, by rule, the Texas Diabetes Care Program for initial implementation in counties selected by HHSC with a high incidence and death rate for diabetes. Subsection (b) requires the program to provide continuous care, including specified preventive services, to Medicaid recipients who have diabetes-related conditions. Requires the commission to consider the program operated in Maryland in developing this program. Subsection (c) requires the Texas Diabetes Council (council) to administer the program under the direction of HHSC. Subsection (d) requires the HHSC and the council to implement the program by November 1, 1997, except as provided by Section 1.04 of this article. SECTION 1.03. Requires HHSC to submit an interim written report to the lieutenant governor and the speaker concerning the effectiveness, including the cost-effectiveness, of the program, no later than September 1, 1998. Requires HHSC to submit a final report by September 1, 1999. SECTION 1.04. Requires HHSC to request a waiver if the commission determines that this is necessary for implementation. Allows for delay of program implementation until the waiver or authorization is granted. SECTION 1.05. Establishes September 1, 2001 as the expiration date of this article. ARTICLE 2. BENEFITS FOR DIABETES CARE PROVIDED UNDER HEALTH BENEFIT PLANS SECTION 2.01. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53D, entitled "Guidelines for Diabetes Care," as follows: Sec. 1. Defines enrollee and health benefit plan. Sec. 2. Subsection (a) establishes that the scope of this article applies only to certain health benefit plans that provides benefits for medical or surgical costs incurred as a result of a health condition accident, or sickness. Provides that this includes individual, group, blanket or franchise insurance contracts; and health service agreements, to the extent permitted by ERISA. Subsection (b) provides that this article does not apply to a plan that provides coverage only for a specified disease, accidental death or dismemberment, disability payments or supplemental liability insurance. Establishes that the article does not apply to a plan under Chapter 26 of the Insurance Code, Medicare supplemental policies, workers' compensation coverage, medical payment insurance issued as part of motor vehicle insurance policy, or a long-term care plan. Sec. 3. Subsection (a) requires the Commissioner of Texas Department of Insurance (TDI), by rule, and in consultation with the council to adopt minimum standards for care provided to diabetic enrollees. Subsection (b) requires each health care benefit plan to provide benefits for care, according to the adopted minimum standards of Subsection (a) of this section. Subsection (c) prohibits any deductible, coinsurance or copayment requirement that exceeds the applicable deductible, coinsurance or copayment applicable to other similar benefits provided under the plan. SECTION 2.02. Requires that the commissioner of TDI, in consultation with the council, adopt minimum standards of care by September 1, 1998, as mandated by Article 21.53D, Insurance Code, which was added by this Act. SECTION 2.03. Establishes that this article only applies to health benefit plans issued or renewed by January 1, 1999. Provides that a policy issued or renewed prior to January 1, 1999, is governed by existing law. ARTICLE 3. DIABETES INFORMATION AND EDUCATION SECTION 3.01. Amends Chapter 103, Health and Safety Code, by amending Section 103.017, and adding Section 103.0175, as follows: Sec. 103.017. PUBLIC AWARENESS AND TRAINING. Requires the strategy developed under Subsection (a) to include a plan under which the council provides public awareness information through businesses, civic organizations, and similar entities. Makes conforming and nonsubstantive changes. Sec. 103.0175. MATERIALS FOR SCHOOL-BASED AND SCHOOL-LINKED CLINICS. Requires the council, in consultation with the TDH to develop and make available materials that provide information about diabetes to be distributed to students and the parents of students by health clinics at public primary or secondary schools. SECTION 3.02. Amends Section 28.002, Education Code, by adding subsection (k) to require the State Board of Education, in consultation with TDH and the council to develop a diabetes education program for school districts to use in health curriculum under Section 28.002(a)(2)(B), Education Code. ARTICLE 4. EFFECTIVE DATE, EMERGENCY CLAUSE SECTION 4.01. This act takes effect September 1, 1997. SECTION 4.02. Emergency clause.