By Berlanga H.B. No. 750 75R1096 PB-F A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to coverage under health benefit plans for certain 1-3 supplies and services associated with the treatment of diabetes. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-6 amended by adding Article 21.53G to read as follows: 1-7 Art. 21.53G. COVERAGE FOR SUPPLIES AND SERVICES ASSOCIATED 1-8 WITH TREATMENT OF DIABETES 1-9 Sec. 1. DEFINITIONS. In this article: 1-10 (1) "Diabetes equipment" means: 1-11 (A) blood glucose monitors, including monitors 1-12 designed to be used by blind individuals; 1-13 (B) insulin pumps and associated appurtenances; 1-14 (C) insulin infusion devices; and 1-15 (D) podiatric appliances for the prevention of 1-16 complications associated with diabetes. 1-17 (2) "Diabetes supplies" means: 1-18 (A) test strips for blood glucose monitors; 1-19 (B) visual reading and urine test strips; 1-20 (C) insulin; 1-21 (D) injection aids; 1-22 (E) syringes; 1-23 (F) prescriptive and nonprescriptive oral agents 1-24 for controlling blood sugar levels; and 2-1 (G) glucagon emergency kits. 2-2 (3) "Health benefit plan" means a plan that provides 2-3 benefits for medical or surgical expenses incurred as a result of a 2-4 health condition, accident, or sickness and that is offered by any 2-5 insurance company, group hospital service corporation, or health 2-6 maintenance organization that delivers or issues for delivery an 2-7 individual, group, blanket, or franchise insurance policy or 2-8 insurance agreement, a group hospital service contract, or an 2-9 evidence of coverage, or, to the extent permitted by the Employee 2-10 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 2-11 seq.), by a multiple employer welfare arrangement as defined by 2-12 Section 3, Employee Retirement Income Security Act of 1974 (29 2-13 U.S.C. Section 1002), or any other analogous benefit arrangement. 2-14 The term does not include: 2-15 (A) a plan that provides coverage: 2-16 (i) only for a specified disease; 2-17 (ii) only for accidental death or 2-18 dismemberment; 2-19 (iii) for wages or payments in lieu of 2-20 wages for a period during which an employee is absent from work 2-21 because of sickness or injury; or 2-22 (iv) as a supplement to liability 2-23 insurance; 2-24 (B) a plan written under Chapter 26 of this 2-25 code; 2-26 (C) a Medicare supplemental policy as defined by 2-27 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 3-1 (D) workers' compensation insurance coverage; 3-2 (E) medical payment insurance issued as part of 3-3 a motor vehicle insurance policy; or 3-4 (F) a long-term care policy, including a nursing 3-5 home fixed indemnity policy, unless the commissioner determines 3-6 that the policy provides benefit coverage so comprehensive that the 3-7 policy meets the definition of a health benefit plan. 3-8 (4) "Qualified insured" means an individual eligible 3-9 for coverage under a health benefit plan who has been diagnosed 3-10 with: 3-11 (A) insulin dependent or noninsulin dependent 3-12 diabetes; 3-13 (B) elevated blood glucose levels induced by 3-14 pregnancy; or 3-15 (C) another medical condition associated with 3-16 elevated blood glucose levels. 3-17 Sec. 2. REQUIRED BENEFIT FOR SUPPLIES AND SERVICES 3-18 ASSOCIATED WITH THE TREATMENT OF DIABETES. A health benefit plan 3-19 that provides benefits for the treatment of diabetes and associated 3-20 conditions must provide coverage to each qualified insured for: 3-21 (1) diabetes equipment; 3-22 (2) diabetes supplies; and 3-23 (3) diabetes self-management training programs. 3-24 Sec. 3. DIABETES SELF-MANAGEMENT TRAINING. Diabetes 3-25 self-management training under this article must be provided by a 3-26 health care practitioner who is licensed, registered, or certified 3-27 in this state to provide appropriate health care services. 4-1 Self-management training includes: 4-2 (1) training provided to a qualified insured after the 4-3 initial diagnosis of diabetes in the care and management of that 4-4 condition, including nutritional counseling and proper use of 4-5 diabetes equipment and supplies; 4-6 (2) additional training authorized on the diagnosis of 4-7 a physician of a significant change in the insured's symptoms or 4-8 condition that requires changes in the insured's self-management 4-9 regime; and 4-10 (3) periodic continuing education training when 4-11 prescribed by an appropriate health care practitioner as warranted 4-12 by the development of new techniques and treatments for diabetes. 4-13 Sec. 4. EFFECT OF NEW TREATMENT MODALITIES. In addition to 4-14 the benefits required under Sections 2 and 3 of this article, on 4-15 the approval of the United States Food and Drug Administration of 4-16 new or improved diabetes equipment or diabetes supplies, including 4-17 improved insulin or other prescription drugs, each health benefit 4-18 plan subject to this article must include coverage of the new or 4-19 improved equipment or supplies. 4-20 Sec. 5. LIMITATION. Benefits required under this article 4-21 may be made subject to a deductible, copayment, or coinsurance 4-22 requirement. A deductible, copayment, or coinsurance required by 4-23 the health benefit plan for benefits under this article may not 4-24 exceed the deductible, copayment, or coinsurance required by the 4-25 health benefit plan for treatment of other analogous chronic 4-26 medical conditions. 4-27 Sec. 6. RULES. The commissioner shall adopt rules as 5-1 necessary for the implementation of this article. The commissioner 5-2 may consult with the commissioner of health and other appropriate 5-3 entities in adopting rules under this section. 5-4 SECTION 2. This Act takes effect September 1, 1997, and 5-5 applies only to a health benefit plan that is delivered, issued for 5-6 delivery, or renewed on or after January 1, 1998. A health benefit 5-7 plan that is delivered, issued for delivery, or renewed before 5-8 January 1, 1998, is governed by the law as it existed immediately 5-9 before the effective date of this Act, and that law is continued in 5-10 effect for this purpose. 5-11 SECTION 3. The importance of this legislation and the 5-12 crowded condition of the calendars in both houses create an 5-13 emergency and an imperative public necessity that the 5-14 constitutional rule requiring bills to be read on three several 5-15 days in each house be suspended, and this rule is hereby suspended.