AN ACT Relating to diabetes education; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; adding a new section to chapter 41.05 RCW; and creating a new section.

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

NEW SECTION. Sec. 1. The legislature finds that diabetes is an insidious disease which affects over one hundred thousand diagnosed diabetics and an equal number of undiagnosed diabetics in Washington state. The legislature also finds that diabetes is the leading cause of blindness as well as kidney failure in the United States in addition to being a major cause of amputations, heart disease, and death from chronic disease.

The legislature finds that diabetics who are unable to get educational expenses reimbursed will not avail themselves of this valuable service because they simply do not understand the relationship between good health management and future diabetes complications or how to balance their medication, exercise, and food consumption to feel well and thereby avoid or delay the complications of this disease.

The legislature also finds that the cost of educating patients to care for themselves is minimal compared to the cost of invasive medical care, lost productivity, and human misery caused by treatment of amputation, kidney failure, blindness, heart disease, and diabetic ketoacidosis.

In order to insure the well-being of all patients in Washington who suffer with diabetes and to forestall or minimize the devastating effects of this disease, the legislature finds it cost-effective and in the best interest of its citizens with diabetes to require reimbursement for diabetes self-management education by health insurance companies as outlined in this act.

NEW SECTION. Sec. 2. A new section is added to chapter 48.20 RCW to read as follows:

(1) Each disability insurance contract issued or renewed after January 1, 1991, that insures for hospital or medical care for diabetes shall provide coverage for diabetes self-management education programs. Coverage shall apply to programs supervised by a licensed physician and prescribed by the covered person's attending physician. Covered diabetes self-management education programs shall be coordinated by a certified diabetes educator and provided by health care professionals including, but not limited to, physicians, registered nurses, registered pharmacists, and certified dietitians who are knowledgeable about the disease process of diabetes and the treatment of patients with diabetes.

This section does not prevent the application of deductible or copayment provisions contained in the policy.

(2) As used in this section, diabetes self-management education program means instruction which will enable persons with diabetes and their families to gain an understanding of the diabetes disease process, and the daily management of diabetic therapy thereby avoiding frequent hospitalizations and complications. This section does not require coverage for programs whose sole purpose is weight reduction.

(3) An insurer need not provide the coverage required by this section to an employer or other group that offers to its eligible enrollees a self-insured health plan that is not subject to mandated benefits under this title and that does not provide coverage for diabetes self-management education programs.

NEW SECTION. Sec. 3. A new section is added to chapter 48.21 RCW to read as follows:

(1) Each group disability insurance contract issued or renewed after January 1, 1991, that insures for hospital or medical care for diabetes shall provide coverage for diabetes self-management education programs. Coverage shall apply to programs supervised by a licensed physician and prescribed by the covered person's attending physician. Covered diabetes self-management education programs shall be coordinated by a certified diabetes educator and provided by health care professionals including, but not limited to, physicians, registered nurses, registered pharmacists, and certified dietitians who are knowledgeable about the disease process of diabetes and the treatment of patients with diabetes.

This section does not prevent the application of deductible or copayment provisions contained in the policy.

NEW SECTION. Sec. 4. A new section is added to chapter 48.44 RCW to read as follows:

(1) Each health care service contract issued or renewed after January 1, 1991, that provides for hospital or medical care for diabetes shall provide coverage for diabetes self-management education programs. Coverage shall apply to programs supervised by a licensed physician and prescribed by the covered person's attending physician. Covered diabetes self-management education programs shall be coordinated by a certified diabetes educator and provided by health care professionals including, but not limited to, physicians, registered nurses, registered pharmacists, and certified dietitians who are knowledgeable about the disease process of diabetes and the treatment of patients with diabetes.

This section does not prevent the application of deductible or copayment provisions contained in the policy.

(3) A health care service contractor need not provide the coverage required by this section to an employer or other group that offers to its eligible enrollees a self-insured health plan that is not subject to mandated benefits under this title and that does not provide coverage for diabetes self-management education programs.

NEW SECTION. Sec. 5. A new section is added to chapter 48.46 RCW to read as follows:

(1) Except as provided in subsection (3) of this section, each health maintenance agreement issued or renewed after January 1, 1991, that provides for hospital or medical care for diabetes shall provide coverage for diabetes self-management education programs when deemed medically necessary and such coverage shall be provided either by the health maintenance organization or upon the health maintenance organization's referral. Programs shall be covered at the usual and customary rates subject to standard contract limitations applicable to other benefits such as deductible amounts or copayments. Coverage shall apply to programs supervised by a licensed physician. Covered diabetes self-management education programs shall be coordinated by a certified diabetes educator and provided by health care professionals including, but not limited to, physicians, registered nurses, registered pharmacists, and certified dietitians who are knowledgeable about the disease process of diabetes and the treatment of patients with diabetes.

(3) A health maintenance organization need not provide the coverage required by this section to an employer or other group that offers to its eligible enrollees a self-insured health plan that is not subject to mandated benefits under this title and that does not provide coverage for diabetes self-management education programs.

NEW SECTION. Sec. 6. A new section is added to chapter 41.05 RCW to read as follows:

(1) Each health plan offered to public employees and their covered dependents under this chapter that is not subject to the provisions of Title 48 RCW and is established or renewed on or after twelve months after the effective date of this act shall include coverage for diabetes self-management education programs. Coverage shall apply to programs supervised by a licensed physician and prescribed by the covered person's attending physician. Covered diabetes self-management education programs shall be coordinated by a certified diabetes educator and provided by health care professionals including, but not limited to, physicians, registered nurses, registered pharmacists, and certified dietitians who are knowledgeable about the disease process of diabetes and the treatment of patients with diabetes.

This section does not prevent the application of deductible or copayment provisions contained in the policy.

(2) As used in this section, diabetes self-management education program means instruction which will enable persons with diabetes to gain an understanding of the diabetes disease process, and the daily management of diabetic therapy thereby avoiding frequent hospitalizations and complications. This section does not require coverage for programs whose sole purpose is weight reduction.