1-1 By: Barrientos, Ellis S.B. No. 162
1-2 (In the Senate - Filed December 30, 1996; January 14, 1997,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; March 3, 1997, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 9, Nays 1;
1-6 March 3, 1997, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 162 By: West
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to prevention and treatment of diabetes.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 ARTICLE 1. TEXAS DIABETES CARE PILOT PROGRAM
1-13 SECTION 1.01. In this article:
1-14 (1) "Commission" means the Health and Human Services
1-15 Commission.
1-16 (2) "Council" means the Texas Diabetes Council.
1-17 (3) "Program" means the Texas Diabetes Care Pilot
1-18 Program established under this article.
1-19 SECTION 1.02. (a) The Health and Human Services Commission
1-20 by rule shall develop a Texas Diabetes Care Pilot Program for
1-21 initial implementation in counties, selected by the commission,
1-22 with a high incidence of and a high death rate from diabetes.
1-23 (b) The program shall provide continuous care, including
1-24 preventive services such as structured outpatient diabetes
1-25 education, nutrition counseling, and case management, to Medicaid
1-26 recipients who have diabetes-related conditions. In developing the
1-27 program, the commission shall consider the program operated in 1993
1-28 and 1994 in Maryland.
1-29 (c) The Texas Diabetes Council shall administer the program
1-30 under the direction of the commission.
1-31 (d) Except as provided by Section 1.04 of this article, the
1-32 commission and the council shall implement the program not later
1-33 than November 1, 1997.
1-34 SECTION 1.03. (a) Not later than September 1, 1998, the
1-35 commission shall submit an interim written report to the lieutenant
1-36 governor and the speaker of the house of representatives on the
1-37 effectiveness, including the cost-effectiveness, of the program.
1-38 (b) Not later than September 1, 1999, the commission shall
1-39 submit a final written report to the lieutenant governor and the
1-40 speaker of the house of representatives on the effectiveness,
1-41 including the cost-effectiveness, of the program.
1-42 SECTION 1.04. If before implementing this article the
1-43 commission determines that a waiver or authorization from a federal
1-44 agency is necessary for implementation, the commission shall
1-45 request the waiver or authorization and may delay implementing this
1-46 section until the waiver or authorization is granted.
1-47 SECTION 1.05. This article expires September 1, 2001.
1-48 ARTICLE 2. BENEFITS FOR DIABETES CARE PROVIDED UNDER HEALTH
1-49 BENEFIT PLANS
1-50 SECTION 2.01. Subchapter E, Chapter 21, Insurance Code, is
1-51 amended by adding Article 21.53D to read as follows:
1-52 Art. 21.53D. GUIDELINES FOR DIABETES CARE
1-53 Sec. 1. DEFINITIONS. In this article:
1-54 (1) "Enrollee" means a person entitled to coverage
1-55 under a health benefit plan.
1-56 (2) "Health benefit plan" means a plan described by
1-57 Section 2 of this article.
1-58 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-59 a health benefit plan that provides benefits for medical or
1-60 surgical expenses incurred as a result of a health condition,
1-61 accident, or sickness, including:
1-62 (1) an individual, group, blanket, or franchise
1-63 insurance policy or insurance agreement, a group hospital service
1-64 contract, or an individual or group evidence of coverage that is
2-1 offered by:
2-2 (A) an insurance company;
2-3 (B) a group hospital service corporation
2-4 operating under Chapter 20 of this code;
2-5 (C) a fraternal benefit society operating under
2-6 Chapter 10 of this code;
2-7 (D) a stipulated premium insurance company
2-8 operating under Chapter 22 of this code; or
2-9 (E) a health maintenance organization operating
2-10 under the Texas Health Maintenance Organization Act (Chapter 20A,
2-11 Vernon's Texas Insurance Code); or
2-12 (2) to the extent permitted by the Employee Retirement
2-13 Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a
2-14 health benefit plan that is offered by:
2-15 (A) a multiple employer welfare arrangement as
2-16 defined by Section 3, Employee Retirement Income Security Act of
2-17 1974 (29 U.S.C. Section 1002); or
2-18 (B) another analogous benefit arrangement.
2-19 (b) This article does not apply to:
2-20 (1) a plan that provides coverage:
2-21 (A) only for a specified disease;
2-22 (B) only for accidental death or dismemberment;
2-23 (C) for wages or payments in lieu of wages for a
2-24 period during which an employee is absent from work because of
2-25 sickness or injury; or
2-26 (D) as a supplement to liability insurance;
2-27 (2) a plan written under Chapter 26 of this code;
2-28 (3) a Medicare supplemental policy as defined by
2-29 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
2-30 (4) workers' compensation insurance coverage;
2-31 (5) medical payment insurance issued as part of a
2-32 motor vehicle insurance policy; or
2-33 (6) a long-term care policy, including a nursing home
2-34 fixed indemnity policy, unless the commissioner determines that the
2-35 policy provides benefit coverage so comprehensive that the policy
2-36 is a health benefit plan as described by Subsection (a) of this
2-37 section.
2-38 Sec. 3. DIABETES CARE GUIDELINES. (a) The department, in
2-39 consultation with the Texas Diabetes Council, shall by rule adopt
2-40 minimum standards for care provided to enrollees with diabetes.
2-41 (b) Each health care benefit plan shall provide benefits for
2-42 the care required by the minimum standards adopted under Subsection
2-43 (a) of this section.
2-44 (c) The benefits required under this article may not be
2-45 subject to a deductible, coinsurance, or copayment requirement that
2-46 exceeds the applicable deductible, coinsurance, or copayment
2-47 applicable to other similar benefits provided under the plan.
2-48 SECTION 2.02. The Texas Department of Insurance shall, in
2-49 consultation with the Texas Diabetes Council, adopt the minimum
2-50 standards of care required under Article 21.53D, Insurance Code, as
2-51 added by this Act, not later than September 1, 1998.
2-52 SECTION 2.03. Article 21.53D, Insurance Code, as added by
2-53 this Act, applies only to a health benefit plan that is delivered,
2-54 issued for delivery, or renewed on or after January 1, 1999. A
2-55 policy that is delivered, issued for delivery, or renewed before
2-56 January 1, 1999, is governed by the law as it existed immediately
2-57 before the effective date of this Act, and that law is continued in
2-58 effect for that purpose.
2-59 ARTICLE 3. DIABETES INFORMATION AND EDUCATION
2-60 SECTION 3.01. Chapter 103, Health and Safety Code, is
2-61 amended by amending Section 103.017 and adding Section 103.0175 to
2-62 read as follows:
2-63 Sec. 103.017. PUBLIC AWARENESS AND TRAINING. (a) The
2-64 department, the Texas Commission for the Blind, the Texas
2-65 Rehabilitation Commission, the Texas Department of Human Services,
2-66 and the Texas [Central] Education Agency shall work with the
2-67 council to jointly develop, produce, and implement a general public
2-68 awareness strategy focusing on diabetes, its complications, and
2-69 techniques for achieving good management. Each agency shall pay
3-1 for the costs of producing and disseminating information on
3-2 diabetes to clients served by that agency.
3-3 (b) The strategy developed under Subsection (a) must include
3-4 a plan under which the council provides public awareness
3-5 information through businesses, civic organizations, and similar
3-6 entities.
3-7 (c) The department, the Texas Commission for the Blind, the
3-8 Texas Rehabilitation Commission, the Texas Department of Human
3-9 Services, and the Texas [Central] Education Agency may jointly
3-10 develop and implement a statewide plan for conducting regional
3-11 training sessions for public and private service providers,
3-12 including institutional health care providers, who have routine
3-13 contact with persons with diabetes.
3-14 (d) [(c)] The council must approve the strategies and plans
3-15 developed under this section.
3-16 Sec. 103.0175. MATERIALS FOR SCHOOL-BASED AND SCHOOL-LINKED
3-17 CLINICS. The council, in consultation with the department, shall
3-18 develop and make available materials that provide information about
3-19 diabetes to be distributed to students and the parents of students
3-20 by health clinics at public primary or secondary schools.
3-21 SECTION 3.02. Section 28.002, Education Code, is amended by
3-22 adding Subsection (k) to read as follows:
3-23 (k) The State Board of Education, in consultation with the
3-24 Texas Department of Health and the Texas Diabetes Council, shall
3-25 develop a diabetes education program that a school district may use
3-26 in the health curriculum under Subsection (a)(2)(B).
3-27 ARTICLE 4. EFFECTIVE DATE; EMERGENCY
3-28 SECTION 4.01. This Act takes effect September 1, 1997.
3-29 SECTION 4.02. The importance of this legislation and the
3-30 crowded condition of the calendars in both houses create an
3-31 emergency and an imperative public necessity that the
3-32 constitutional rule requiring bills to be read on three several
3-33 days in each house be suspended, and this rule is hereby suspended.
3-34 * * * * *