SENATE BILL REPORT

SB 5957

BYSenators Smitherman, von Reichbauer, Wojahn, Gaspard, Warnke and Johnson

Mandating coverage for diabetic education.

Senate Committee on Health & Long-Term Care

Senate Hearing Date(s):

Senate Staff:Don Sloma (786-7414)

AS OF JANUARY 25, 1990

BACKGROUND:

Insurers that provide coverage for complications relating to diabetes do not always provide coverage for diabetes self-management education programs.  Diabetes self-management education includes programs about self-care for people afflicted with diabetes.  These programs include instruction on diet, self-blood sugar testing, recognition and treatment of the symptoms of diabetes, techniques for injecting insulin, techniques for caring for diabetes to prevent acute complications, and general wellness training to prevent complications of diabetes.

Insurers are not required to provide coverage for diabetes self-management education programs.  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 programs.  Requiring insurance coverage for these education programs, it has been suggested, would make diabetes self-management education more accessible, and thus, help decrease the number of serious complications resulting from diabetes.

SUMMARY:

A disability insurance contract, group disability insurance contract, group health care service contract or health maintenance agreement issued or renewed after January 1, 1990 must provide coverage for diabetes self-management education programs.  These programs must be supervised by a licensed physician and must be coordinated by a certified diabetes educator.  The coverage applies if the insurance contract provides coverage for hospital medical care.  The application of deductible or copayment provisions contained in a policy of medical insurance is permitted.

Diabetes self-management education is defined as instruction that will enable persons with diabetes to gain an understanding of the diabetes disease process and the daily management of diabetic therapy in order to avoid frequent hospitalization and complications.  Programs whose sole purpose is weight reduction are not mandated to be covered.

EFFECT OF PROPOSED SUBSTITUTE:

The reference to registered dietitians is changed to certified dietitians.  The patient's attending physician must prescribe the diabetes self-management education program before coverage applies.  The insurance coverage required need not cover education for the families of the insured.  The state public employees insurance program must provide the same diabetes education coverage as other insurers.

Appropriation:    none

Revenue:    none

Fiscal Note:      requested