28 Tex. Admin. Code § 21.2606 - Diabetes Self-Management Training
(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.
Notes
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