By: Barrientos, Ellis S.B. No. 162
A BILL TO BE ENTITLED
AN ACT
1-1 relating to prevention and treatment of diabetes.
1-2 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-3 ARTICLE 1. TEXAS DIABETES CARE PILOT PROGRAM
1-4 SECTION 1.01. In this article:
1-5 (1) "Commission" means the Health and Human Services
1-6 Commission.
1-7 (2) "Council" means the Texas Diabetes Council.
1-8 (3) "Program" means the Texas Diabetes Care Pilot
1-9 Program established under this article.
1-10 SECTION 1.02. (a) The Health and Human Services Commission
1-11 by rule shall develop a Texas Diabetes Care Pilot Program for
1-12 initial implementation in counties, selected by the commission,
1-13 with a high incidence of and a high death rate from diabetes.
1-14 (b) The program shall provide continuous care, including
1-15 preventive services such as structured outpatient diabetes
1-16 education, nutrition counseling, and case management, to Medicaid
1-17 recipients who have diabetes-related conditions. In developing the
1-18 program, the commission shall consider the program operated in 1993
1-19 and 1994 in Maryland.
1-20 (c) The Texas Diabetes Council shall administer the program
1-21 under the direction of the commission.
1-22 (d) Except as provided by Section 1.04 of this article, the
1-23 commission and the council shall implement the program not later
2-1 than November 1, 1997.
2-2 SECTION 1.03. (a) Not later than September 1, 1998, the
2-3 commission shall submit an interim written report to the lieutenant
2-4 governor and the speaker of the house of representatives on the
2-5 effectiveness, including the cost-effectiveness, of the program.
2-6 (b) Not later than September 1, 1999, the commission shall
2-7 submit a final written report to the lieutenant governor and the
2-8 speaker of the house of representatives on the effectiveness,
2-9 including the cost-effectiveness, of the program.
2-10 SECTION 1.04. If before implementing this article the
2-11 commission determines that a waiver or authorization from a federal
2-12 agency is necessary for implementation, the commission shall
2-13 request the waiver or authorization and may delay implementing this
2-14 section until the waiver or authorization is granted.
2-15 SECTION 1.05. This article expires September 1, 2001.
2-16 ARTICLE 2. BENEFITS FOR DIABETES CARE PROVIDED UNDER HEALTH
2-17 BENEFIT PLANS
2-18 SECTION 2.01. Subchapter E, Chapter 21, Insurance Code, is
2-19 amended by adding Article 21.53D to read as follows:
2-20 Art. 21.53D. GUIDELINES FOR DIABETES CARE
2-21 Sec. 1. DEFINITIONS. In this article:
2-22 (1) "Enrollee" means a person entitled to coverage
2-23 under a health benefit plan.
2-24 (2) "Health benefit plan" means a plan described by
2-25 Section 2 of this article.
3-1 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
3-2 a health benefit plan that provides benefits for medical or
3-3 surgical expenses incurred as a result of a health condition,
3-4 accident, or sickness, including:
3-5 (1) an individual, group, blanket, or franchise
3-6 insurance policy or insurance agreement, a group hospital service
3-7 contract, or an individual or group evidence of coverage that is
3-8 offered by:
3-9 (A) an insurance company;
3-10 (B) a group hospital service corporation
3-11 operating under Chapter 20 of this code;
3-12 (C) a fraternal benefit society operating under
3-13 Chapter 10 of this code;
3-14 (D) a stipulated premium insurance company
3-15 operating under Chapter 22 of this code; or
3-16 (E) a health maintenance organization operating
3-17 under the Texas Health Maintenance Organization Act (Chapter 20A,
3-18 Vernon's Texas Insurance Code); or
3-19 (2) to the extent permitted by the Employee Retirement
3-20 Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a
3-21 health benefit plan that is offered by:
3-22 (A) a multiple employer welfare arrangement as
3-23 defined by Section 3, Employee Retirement Income Security Act of
3-24 1974 (29 U.S.C. Section 1002); or
3-25 (B) another analogous benefit arrangement.
4-1 (b) This article does not apply to:
4-2 (1) a plan that provides coverage:
4-3 (A) only for a specified disease;
4-4 (B) only for accidental death or dismemberment;
4-5 (C) for wages or payments in lieu of wages for a
4-6 period during which an employee is absent from work because of
4-7 sickness or injury;
4-8 (D) as a supplement to liability insurance;
4-9 (E) dental or vision care only; or
4-10 (F) hospital confinement indemnity coverage
4-11 only;
4-12 (2) a plan written under Chapter 26 of this code;
4-13 (3) a Medicare supplemental policy as defined by
4-14 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
4-15 (4) workers' compensation insurance coverage;
4-16 (5) medical payment insurance issued as part of a
4-17 motor vehicle insurance policy; or
4-18 (6) a long-term care policy, including a nursing home
4-19 fixed indemnity policy, unless the commissioner determines that the
4-20 policy provides benefit coverage so comprehensive that the policy
4-21 is a health benefit plan as described by Subsection (a) of this
4-22 section.
4-23 Sec. 3. DIABETES CARE GUIDELINES. (a) The commissioner, in
4-24 consultation with the Texas Diabetes Council, shall by rule adopt
4-25 minimum standards for benefits provided to enrollees with diabetes.
5-1 (b) Each health care benefit plan shall provide benefits for
5-2 the care required by the minimum standards adopted under Subsection
5-3 (a) of this section.
5-4 (c) The benefits required under this article may not be
5-5 subject to a deductible, coinsurance, or copayment requirement that
5-6 exceeds the applicable deductible, coinsurance, or copayment
5-7 applicable to other similar benefits provided under the plan.
5-8 SECTION 2.02. The Commissioner of Insurance shall, in
5-9 consultation with the Texas Diabetes Council, adopt the minimum
5-10 benefits required under Article 21.53D, Insurance Code, as added by
5-11 this Act, not later than September 1, 1998.
5-12 SECTION 2.03. Article 21.53D, Insurance Code, as added by
5-13 this Act, applies only to a health benefit plan that is delivered,
5-14 issued for delivery, or renewed on or after January 1, 1999. A
5-15 policy that is delivered, issued for delivery, or renewed before
5-16 January 1, 1999, is governed by the law as it existed immediately
5-17 before the effective date of this Act, and that law is continued in
5-18 effect for that purpose.
5-19 ARTICLE 3. DIABETES INFORMATION AND EDUCATION
5-20 SECTION 3.01. Chapter 103, Health and Safety Code, is
5-21 amended by amending Section 103.017 and adding Section 103.0175 to
5-22 read as follows:
5-23 Sec. 103.017. PUBLIC AWARENESS AND TRAINING. (a) The
5-24 department, the Texas Commission for the Blind, the Texas
5-25 Rehabilitation Commission, the Texas Department of Human Services,
6-1 and the Texas [Central] Education Agency shall work with the
6-2 council to jointly develop, produce, and implement a general public
6-3 awareness strategy focusing on diabetes, its complications, and
6-4 techniques for achieving good management. Each agency shall pay
6-5 for the costs of producing and disseminating information on
6-6 diabetes to clients served by that agency.
6-7 (b) The strategy developed under Subsection (a) must include
6-8 a plan under which the council provides public awareness
6-9 information through businesses, civic organizations, and similar
6-10 entities.
6-11 (c) The department, the Texas Commission for the Blind, the
6-12 Texas Rehabilitation Commission, the Texas Department of Human
6-13 Services, and the Texas [Central] Education Agency may jointly
6-14 develop and implement a statewide plan for conducting regional
6-15 training sessions for public and private service providers,
6-16 including institutional health care providers, who have routine
6-17 contact with persons with diabetes.
6-18 (d) [(c)] The council must approve the strategies and plans
6-19 developed under this section.
6-20 Sec. 103.0175. MATERIALS FOR SCHOOL-BASED AND SCHOOL-LINKED
6-21 CLINICS. The council, in consultation with the department, shall
6-22 develop and make available materials that provide information about
6-23 diabetes to be distributed to students and the parents of students
6-24 by health clinics at public primary or secondary schools.
6-25 SECTION 3.02. Section 28.002, Education Code, is amended by
7-1 adding Subsection (k) to read as follows:
7-2 (k) The State Board of Education, in consultation with the
7-3 Texas Department of Health and the Texas Diabetes Council, shall
7-4 develop a diabetes education program that a school district may use
7-5 in the health curriculum under Subsection (a)(2)(B).
7-6 ARTICLE 4. EFFECTIVE DATE; EMERGENCY
7-7 SECTION 4.01. This Act takes effect September 1, 1997.
7-8 SECTION 4.02. The importance of this legislation and the
7-9 crowded condition of the calendars in both houses create an
7-10 emergency and an imperative public necessity that the
7-11 constitutional rule requiring bills to be read on three several
7-12 days in each house be suspended, and this rule is hereby suspended.