By Zaffirini S.B. No. 163
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.