SECTION 61.21. General Information

(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.

Source Note: The provisions of this §61.21 adopted to be effective July 23, 1990, 15 TexReg 3853; amended to be effective July 25, 2004, 29 TexReg 6905