Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 61 - CHRONIC DISEASES › Subchapter B - DIABETIC EYE DISEASE DETECTION INITIATIVE › Section 61.21 - General Information

Current through Reg. 49, No. 28; July 12, 2024
(a) Background.
				  Diabetes is a major cause of blindness in the United States and in Texas. It is
				  estimated that up to 50% of blindness due to proliferative diabetic retinopathy
				  could be prevented, or at least delayed, by prompt detection and treatment.
				  Annual funduscopic examinations are recommended for nearly all people with
				  diabetes to detect retinopathy before vision is compromised. Unfortunately,
				  many people with diabetes are not presently being referred to ophthalmic
				  specialists to receive these annual examinations. While several factors
				  contribute to the problem, lack of resources is a significant factor. The
				  prevalence of diabetes is greater among minority populations. Specifically, the
				  prevalence of diabetes is higher among Hispanics/Latinos, American Indians,
				  Asian Americans, and African Americans than non-Hispanic whites. Existing
				  evidence also indicates that minority populations suffer disproportionately
				  higher rates of complications from diabetes. For these reasons, the Texas
				  Department of Health or its successor (department), and the Texas Diabetes
				  Council support diabetic eye disease screening activities.
(b) Introduction. The purpose of the Diabetic
				  Eye Disease Program (DEDP) is to provide dilated funduscopic examinations to
				  eligible persons with diabetes who might otherwise not receive services so that
				  vision-threatening conditions, such as retinopathy, can be identified and
				  treated. These services are provided to Texas residents who are at high risk
				  for vision loss due to diabetes, and who meet the program's income eligibility
				  criteria for services.
(c)
				  Participating providers. Health care professionals providing DEDP services must
				  have a current Texas license to practice ophthalmology or optometry and must be
				  in good standing with the Texas Board of Medical Examiners or Texas Optometry
				  Board, whichever is applicable. Persons wishing to become providers should
				  complete the information requested on the department's fee-for-service contract
				  and return the completed contract to the Texas Diabetes Program, 1100 West 49th
				  Street, Austin, Texas 78756.
(d)
				  Procedures for eligible persons receiving services from the DEDP. Individuals
				  must be referred by regional department staff, local health departments, or
				  others who have been approved as nominators by the program. The nominator's
				  responsibility is to assess whether a prospective client with diabetes meets
				  DEDP eligibility criteria, and to refer the client to a participating provider.
				  Nominators should also assist in follow-up with clients and providers regarding
				  missed appointments and any need for subsequent treatment for eye disease. The
				  nominator will then refer the client and send a tracking form to the provider.
				  This form is the written authorization for the provider to perform services.
				  Upon completion of the client's examination, the provider will forward a copy
				  of the tracking form to the DEDP office and retain a copy for the provider's
				  record. If treatment is recommended and the client is to be referred to another
				  facility for treatment, then the provider will forward a copy of the tracking
				  form to the treatment facility. If the provider is also performing treatment,
				  the results of the treatment will be documented on the tracking form and sent
				  to the Texas Diabetes Program in Austin. However, the DEDP will pay only for
				  the funduscopic eye exam and is not authorized to pay for eyeglasses, contact
				  lenses, or any indicated follow-up care.