1-1     By:  Madla                                             S.B. No. 982
 1-2           (In the Senate - Filed March 8, 1999; March 9, 1999, read
 1-3     first time and referred to Committee on Health Services;
 1-4     April 15, 1999, reported adversely, with favorable Committee
 1-5     Substitute by the following vote:  Yeas 5, Nays 0; April 15, 1999,
 1-6     sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 982                    By:  Nixon
 1-8                            A BILL TO BE ENTITLED
 1-9                                   AN ACT
1-10     relating to persons authorized to provide diabetes self-management
1-11     training.
1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13           SECTION 1.  Section 4, Article 21.53G, Insurance Code, is
1-14     amended to read as follows:
1-15           Sec. 4.  Diabetes Self-Management Training.  (a)  Diabetes
1-16     self-management training under this article must be provided by a
1-17     health care practitioner or provider who is licensed, registered,
1-18     or certified in this state to provide appropriate health care
1-19     services, acting within the scope of practice authorized by the
1-20     license, registration, or certification of the practitioner or
1-21     provider.  Self-management training includes:
1-22                 (1)  training provided to a qualified insured after the
1-23     initial diagnosis of diabetes in the care and management of that
1-24     condition, including nutritional counseling and proper use of
1-25     diabetes equipment and supplies;
1-26                 (2)  additional training authorized on the diagnosis of
1-27     a physician or other health care practitioner of a significant
1-28     change in the qualified insured's symptoms or condition that
1-29     requires changes in the qualified insured's self-management regime;
1-30     and
1-31                 (3)  periodic or episodic continuing education training
1-32     when prescribed by an appropriate health care practitioner as
1-33     warranted by the development of new techniques and treatments for
1-34     diabetes.
1-35           (b)  A health benefit plan shall provide diabetes
1-36     self-management training or coverage for diabetes self-management
1-37     training for which a physician or practitioner has written an order
1-38     to each insured or the caretaker of the insured from:
1-39                 (1)  a diabetes self-management training program
1-40     recognized by the American Diabetes Association;
1-41                 (2)  a multidisciplinary team, coordinated by a
1-42     Certified Diabetes Educator who is certified by the National
1-43     Certification Board for Diabetes Educators or a person who has
1-44     completed at least 24 hours of approved continuing education that
1-45     includes a combination of diabetes education, educational
1-46     principles, and behavioral strategies, consisting of at least a
1-47     dietitian and a nurse educator who collaborate routinely and which
1-48     may include a pharmacist and a social worker, and each member of
1-49     which, other than a social worker, must have recent didactic and
1-50     experiential preparation in diabetes clinical and educational
1-51     issues;
1-52                 (3)  a Certified Diabetes Educator who is certified by
1-53     the National Certification Board for Diabetes Educators;
1-54                 (4)  a licensed health care practitioner, including a
1-55     physician, a physician assistant, a registered nurse, a licensed
1-56     dietitian, or a pharmacist, who has been determined by the
1-57     practitioner's licensing board to have recent didactic and
1-58     experiential preparation in diabetes clinical and educational
1-59     issues; or
1-60                 (5)  the following licensed health care practitioners
1-61     or providers, who may provide a component or components of a
1-62     diabetes self-management training program:
1-63                       (A)  a licensed dietitian, who may provide any
1-64     nutritional counseling component;
 2-1                       (B)  a pharmacist, who may provide any
 2-2     pharmaceutical component; or
 2-3                       (C)  a physician, a physician assistant, a
 2-4     registered nurse, or an advanced practice nurse, who may provide
 2-5     any other component of the training.
 2-6           (c)  In this section, the term "nutritional counseling" has
 2-7     the meaning assigned the term "nutrition counseling" in Section
 2-8     2(12), Licensed Dietitian Act (Article 4512h, Vernon's Texas Civil
 2-9     Statutes).
2-10           (d)  In consultation with the Texas Diabetes Council, the
2-11     appropriate licensing board of practitioners or providers
2-12     authorized to provide diabetes self-management training in
2-13     accordance with this section shall by rule determine the recent
2-14     didactic and experiential preparation in diabetes clinical and
2-15     educational issues required by this section to qualify licensees of
2-16     the board to provide the training and shall by rule determine and
2-17     define the component or components of diabetes self-management
2-18     training authorized by Subsections (b)(5)(B) and (C) of this
2-19     section.
2-20           SECTION 2.  This Act takes effect September 1, 1999, and
2-21     applies only to a health benefit plan that is delivered, issued for
2-22     delivery, or renewed on or after January 1, 2000.  A health benefit
2-23     plan that is delivered, issued for delivery, or renewed before
2-24     January 1, 2000, is governed by the law as it existed immediately
2-25     before the effective date of this Act, and that law is continued in
2-26     effect for that purpose.
2-27           SECTION 3.  The importance of this legislation and the
2-28     crowded condition of the calendars in both houses create an
2-29     emergency and an imperative public necessity that the
2-30     constitutional rule requiring bills to be read on three several
2-31     days in each house be suspended, and this rule is hereby suspended.
2-32                                  * * * * *