| (a) A health benefit plan must provide diabetes self-management
training or coverage for diabetes self-management training for which
a physician or practitioner has written an order, including a written
order of a practitioner practicing under protocols jointly developed
with a physician, to each insured or the caretaker of the insured
in accordance with the standards contained in Insurance Code §1358.054.
(b) A person may not provide a component of diabetes
self-management training under subsection (a) of this section unless
the subject matter of the component is within the scope of the person's
practice and the person meets the education requirements as determined
by the person's licensing agency in consultation with the Commissioner
of Public Health.
(c) Self-management training should include the development
of an individualized management plan that is created for and in collaboration
with the insured and that meets the requirements of the minimum standards
for benefits in accordance with §21.2604 of this title (relating
to Minimum Standards for Benefits for Persons with Diabetes).
(d) Nutrition counseling and instructions on the proper
use of diabetes equipment and supplies must be provided or covered
as part of the training.
(e) Diabetes self-management training must be provided,
or coverage for diabetes self-management training must be provided
to an insured or a caretaker, upon the following occurrences relating
to an insured, provided that any training involving the administration
of medications must comply with the applicable delegation rules from
the appropriate licensing agency:
(1) the initial diagnosis of diabetes;
(2) the written order of a physician or practitioner
indicating that a significant change in the symptoms or condition
of the insured requires changes in the insured's self-management regime;
(3) the written order of a physician or practitioner
that periodic or episodic continuing education is warranted by the
development of new techniques and treatment for diabetes.
(f) An HMO must provide oversight of its diabetes self-management
training program on an ongoing basis to ensure compliance with this
section.
(g) Health benefit plans provided by entities other
than HMOs must disclose in the plan how to access providers or benefits
described in subsection (a) of this section.
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| Source Note: The provisions of this §21.2606 adopted to be effective April 13, 1999, 24 TexReg 2939; amended to be effective July 27, 2003, 28 TexReg 5657; amended to be effective November 7, 2021, 46 TexReg 7408 |
