SRC-CDH S.B. 163 75(R)    BILL ANALYSIS


Senate Research CenterS.B. 163
By: Zaffirini
Economic Development
3-12-97
As Filed


DIGEST 

Currently, health benefit plans are not required to cover preventive care
costs associated with diabetes, a disease which ranks sixth among the 10
leading causes of death for Texans; affects almost seven percent of the
adult population; and cost Texans roughly $4 billion in direct medical
costs and lost productivity in 1992.  A major expense associated with
diabetes occurs when the condition is left untreated.  Some health benefit
plans do not cover preventative care which may increase the overall
medical cost.  S.B. 163 requires health plans which provide benefits for
the treatment of diabetes to cover diabetes equipment, supplies, and
self-management training programs. 

PURPOSE

As proposed, S.B. 163 provides coverage under health benefit plans for
certain supplies and services associated with the treatment of diabetes. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the commissioner of insurance in
SECTION 1 (Section 6, Article 21.53G, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 21E, Insurance Code, by adding Article 21.53G,
as follows: 

Art. 21.53G.  COVERAGE FOR SUPPLIES AND SERVICES ASSOCIATED WITH TREATMENT
OF DIABETES 

Sec. 1. DEFINITIONS.  Defines "diabetes equipment," "diabetes supplies,"
"health benefit plan," and "qualified insured." 

Sec. 2. REQUIRED BENEFIT FOR SUPPLIES AND SERVICES ASSOCIATED WITH THE
TREATMENT OF DIABETES.  Requires a health benefit plan that provides
benefits for the treatment of diabetes and associated conditions to
provide coverage to each qualified insured for diabetes equipment,
diabetes supplies, and diabetes self-management training programs.   

Sec. 3. DIABETES SELF-MANAGEMENT TRAINING.  Requires diabetes
selfmanagement training to be provided by a health care practitioner who
is licensed, registered, or certified in this state to provide appropriate
health care services.    Sets forth the types of training included as
self-management training.   

Sec. 4. EFFECT OF NEW TREATMENT MODALITIES.  Requires each health benefit
plan subject to this article to include coverage of new or improved
equipment or supplies approved by the United States Food and Drug
Administration, including improved insulin or other prescription drugs.   

Sec. 5. LIMITATION.  Authorizes benefits required under this article to be
made subject to a deductible, copayment, or coinsurance requirement and
prohibits the requirement from exceeding the deductible, copayment, or
coinsurance required by the health benefit plan for  treatment of other
analogous chronic medical conditions. 

Sec. 6. RULES.  Requires the commissioner of insurance to adopt rules as
necessary for the implementation of this article. Authorizes the
commissioner to consult with the commissioner of health and other
appropriate entities in adopting rules under this section.  
SECTION 2. Effective date:  September 1, 1997. 
  Makes application of this Act prospective to January 1, 1998.  

SECTION 3. Emergency clause.