By: McReynolds, Guillen, Leibowitz H.B. No. 1990

(Senate Sponsor - Duncan)

(In the Senate - Received from the House April 24, 2009; May 1, 2009, read first time and referred to Committee on Health and Human Services; May 8, 2009, reported favorably by the following vote: Yeas 8, Nays 0; May 8, 2009, sent to printer.)

A BILL TO BE ENTITLED

AN ACT

relating to a diabetes self-management training pilot program under the state Medicaid program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 531, Government Code, is amended by adding Section 531.0319 to read as follows:

Sec. 531.0319. DIABETES SELF-MANAGEMENT TRAINING PILOT PROGRAM. (a) Notwithstanding Section 32.057, Human Resources Code, or Section 533.009 and to the extent allowed by federal law, the commission shall establish a pilot program to provide diabetes self-management training services to selected Medicaid recipients.

(b) The commission may select a person to participate in the pilot program if the person is:

(1) a recipient of Medicaid under the fee-for-service or primary care case management delivery model;

(2) diagnosed with diabetes; and

(3) enrolled in a disease management program available to Medicaid recipients.

(c) In establishing the pilot program the commission shall ensure that:

(1) either:

(A) a provider of diabetes self-management training under the program is certified to provide the training in accordance with the quality standards for diabetes self-management training services described by the Medicare Benefit Policy Manual, Chapter 15, Section 300, as effective on January 1, 2009; or

(B) a certified diabetes educator is hired to provide the training;

(2) an assessment of a potential participant in the program is conducted that includes a review of the person's medical history, risk factors, health status, resource utilization, knowledge and skill level, and cultural barriers to effective diabetes self-management;

(3) a participant is offered a minimum of:

(A) 10 hours of initial self-management training with a diabetes educator; and

(B) three hours of initial nutrition education with a registered dietitian or with a diabetes educator if a registered dietitian is not available;

(4) after receipt of the initial self-management training and nutrition education, the participant is offered each year a minimum of:

(A) two hours of self-management training with a diabetes educator; and

(B) two hours of nutrition education with a registered dietitian or with a diabetes educator if a registered dietitian is not available;

(5) if diabetes self-management training is provided in group sessions, the participant has direct, face-to-face interaction with the diabetes educator and is offered a sufficient number of individual sessions to meet the participant's cultural and educational needs; and

(6) the participant may repeat all or part of the self-management training as medically necessary, regardless of whether the participant is diagnosed with a new health condition or experiences a change in health status.

(d) The commission shall ensure that the pilot program measures the progress of program participants while enrolled in the program using specific health outcomes for diabetes disease management.

(e) Information collected by the commission during the pilot program is confidential and may be disclosed only as authorized by this section in a manner that prevents disclosure of individually identifiable information.

(f) Not later than December 1, 2012, the commission shall submit a report to the governor, lieutenant governor, speaker of the house of representatives, standing committees of the legislature with appropriate subject matter jurisdiction, and Texas Diabetes Council regarding:

(1) the data and outcomes that result from the diabetes self-management training pilot program; and

(2) any other relevant information as determined by the commission.

(g) This section expires September 1, 2013.

SECTION 2. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 3. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2009.

* * * * *