HOUSE BILL REPORT

HB 2583

BYRepresentatives 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

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass. (8)

      Signed by Representatives Dellwo, Chair; Anderson, Crane, Day, Inslee, Nutley, K. Wilson and Winsley

Minority Report:  Do not pass.  (4)

      Signed by Representatives Zellinsky, Vice Chair; Baugher, Beck and Dorn.

House Staff:John Conniff (786-7119)

AS REPORTED BY COMMITTEE ON FINANCIAL INSTITUTIONS & INSURANCE

JANUARY 26, 1990

BACKGROUND:

Diabetics can benefit from an education program designed to teach diabetics how to manage the disease.  However, some diabetics do not avail themselves of the education program because of the costs of the program.  Some health insurance plans cover the costs of diabetic education; many health insurance plans do not.

SUMMARY:

SUBSTITUTE BILL:  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 as defined. 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.

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.

SUBSTITUTE BILL COMPARED TO ORIGINAL:  Technical corrections are made and the mandated coverage is required for Washington state employee health benefit plans.  In addition, insurers, health care service contractors, and health maintenance organizations need not offer the mandated coverage to an employer who offers its employees a self-insured health benefit plan that does not include the mandated coverage.

Fiscal Note:      Requested January 26, 1990.

House Committee ‑ Testified For:    Jan Norman, Washington Association of Diabetic Education; Merrillann Hutchinson, Washington Association of Diabetic Education and Group Health Cooperative; Carl Knirk, American Diabetes Association; Wade St. Amand; Margaret Casey, Washington State Diabetes Association; H. Brownie Braunsteiner; Bob Halversen; and William Mitchell, Center for Disease Control.

House Committee - Testified Against:      Mel Sorensen, Washington Physicians Service and Blue Cross; Ken Bertrand, Group Health Cooperative; Basil Badley, Health Insurance Association of America; and Clif Finch, Association of Washington Business

House Committee - Testimony For:    The proposed mandated coverage has been favorably reviewed by the State Health Coordinating Council in accordance with statutory requirements for such review.  Studies have shown that diabetic self-management education programs save money by reducing the incidence of hospitalization and medical treatment for diabetics who have received training.  Some insurance companies, contractors and health maintenance organizations provide coverage for such education, others do not.  Mandating this education coverage will improve the health of diabetics and thereby reduce health care costs

House Committee - Testimony Against:      Whether or not diabetic self-management education programs reduce health care costs, every mandated health insurance benefit, no matter how desirable, increases the overall cost of health insurance.  Moreover, experience shows that when a new benefit is mandated, there is a corresponding increase in the number of health professionals who provide the services covered by the mandate thereby increasing the utilization and cost of the services.  This mandated coverage, like all other mandated coverages, further contributes to the loss of market share by regulated health care payors to self-insured employer health benefit plans.