2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle E - Benefits Payable Under Health Coverages › Chapter 1358 - Diabetes › Subchapter B. Supplies and Services Associated With Diabetes Treatment › Section 1358.055. Diabetes Self-Management Training

Sec. 1358.055.  DIABETES SELF-MANAGEMENT TRAINING.  (a)  Diabetes self-management training must be provided by a health care practitioner or provider who is:
(1)  licensed, registered, or certified in this state to provide appropriate health care services;  and
(2)  acting within the scope of practice authorized by the license, registration, or certification.
(b)  For purposes of this subchapter, "self-management training" includes:
(1)  training provided to a qualified enrollee, after the initial diagnosis of diabetes, in the care and management of that condition, including nutrition counseling and counseling on the proper use of diabetes equipment and supplies;
(2)  additional training authorized on the diagnosis of a physician or other health care practitioner of a significant change in the qualified enrollee's symptoms or condition that requires changes in the qualified enrollee's self-management regime;  and
(3)  periodic or episodic continuing education training prescribed by an appropriate health care practitioner as warranted by the development of new techniques or treatments for diabetes.
(c)  If the diabetes self-management training is provided on the written order of a physician or other health care practitioner, including a health care practitioner practicing under protocols jointly developed with a physician, the training must also include:
(1)  a diabetes self-management training program recognized by the American Diabetes Association;
(2)  diabetes self-management training provided by a multidisciplinary team:
(A)  the nonphysician members of which are coordinated by:
(i)  a diabetes educator who is certified by the National Certification Board for Diabetes Educators;  or
(ii)  an individual who has completed at least 24 hours of continuing education that meets guidelines established by the Texas Board of Health and that includes a combination of diabetes-related educational principles and behavioral strategies;
(B)  that consists of at least a licensed dietitian and a registered nurse and may include a pharmacist and a social worker;  and
(C)  each member of which, other than a social worker, has recent didactic and experiential preparation in diabetes clinical and educational issues as determined by the member's licensing agency, in consultation with the commissioner of public health, unless the member's licensing agency, in consultation with the commissioner of public health, determines that the core educational preparation for the member's license includes the skills the member needs to provide diabetes self-management training;
(3)  diabetes self-management training provided by a diabetes educator certified by the National Certification Board for Diabetes Educators;  or
(4)  diabetes self-management training that provides one or more of the following components:
(A)  a nutrition counseling component provided by a licensed dietitian, for which the licensed dietitian shall be paid;
(B)  a pharmaceutical component provided by a pharmacist, for which the pharmacist shall be paid;
(C)  a component provided by a physician assistant or registered nurse, for which the physician assistant or registered nurse shall be paid, except that the physician assistant or registered nurse may not be paid for providing a nutrition counseling or pharmaceutical component unless a licensed dietitian or pharmacist is unavailable to provide that component;  or
(D)  a component provided by a physician.
(d)  An individual may not provide a component of diabetes self-management training under Subsection (c)(4) unless:
(1)  the subject matter of the component is within the scope of the individual's practice;  and
(2)  the individual meets the education requirements, as determined by the individual's licensing agency in consultation with the commissioner of public health.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.