SENATE BILL REPORT

SHB 2583

BYHouse Committee on Financial Institutions & Insurance (originally sponsored by Representatives May, Dellwo, Betrozoff, Prentice, Moyer, Rasmussen, Bowman, Wolfe, Walker, Rector, Wood, Winsley, Day and Brekke)

Mandating coverage for diabetic education.

House Committe on Financial Institutions & Insurance

Senate Committee on Financial Institutions & Insurance

Senate Hearing Date(s):February 20, 1990; February 23, 1990

Majority Report:  Do pass as amended.

      Signed by Senators von Reichbauer, Chairman; Johnson, Vice Chairman; Fleming, McCaslin, Rasmussen, Smitherman, West.

Senate Staff:Benson Porter (786-7470)

                  February 26, 1990

AS REPORTED BY COMMITTEE ON FINANCIAL INSTITUTIONS & INSURANCE, FEBRUARY 23, 1990

BACKGROUND:

Diabetes self-management programs are available to teach diabetics how to self-manage the disease.  These programs include instruction on diet, self-blood sugar testing, recognition and treatment of the symptoms of diabetes, techniques for injecting insulin, and general wellness training to prevent complications of diabetes.  However, concern has been raised that some diabetics do not avail themselves of these education programs because of the costs of the programs.

Currently, health insurance plans are not required to cover the costs of diabetic education.  It has been suggested that complications from diabetes can be minimized or prevented if more people afflicted with diabetes have access to self-management education.

SUMMARY:

Health plans offered to Washington State employees, individual and group disability insurance policies, health care service contracts, and health maintenance agreements must provide coverage for diabetes self-management education programs.  Coverage applies only when recommended by the attending physician and only to programs supervised by a licensed physician, coordinated by a certified diabetes educator, and provided by a health care professional.  Coverage does not apply to programs whose sole purpose is weight reduction.

A diabetes self-management education program is defined as instruction that develops understanding of the diabetes disease process and the daily management of diabetic therapy necessary to avoid frequent hospitalizations and complications.

No provision of the act prohibits the application of deductible and copayment provisions contained in a policy, contract, or agreement.

Coverage need not be provided in a group policy, contract or agreement sold to an employer who offers employees a self-insured plan that does not also provide benefits for diabetes self-management education.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

SUMMARY OF PROPOSED SENATE AMENDMENTS:

A health plan offered to state employees, individual and group disability contracts, and health care contracts may contain a maximum lifetime diabetes self-management program benefit.  The benefit must be at least $250.  In addition, the commissioner may adjust the minimum benefit from time to time to reflect changes in the Consumer Price Index in Seattle.

The diabetes self-management program covered in this act may not exceed 30 hours of group instruction, which may include two hours of individual instruction, or two hours of individual instruction.

This act does not apply to contracts or agreements that only provide coverage for Medicare supplement, specified disease, or other limited benefit coverage.

Senate Committee - Testified: Kathy Johnson, Washington Association of Diabetes Educators (pro); Jan Norman, President-Elect, Washington Association of diabetes Educators (pro); Ken Bertrand, Group Health (con)