By:  Delisi, Capelo, et al.                                       H.B. No. 727



A BILL TO BE ENTITLED

AN ACT

relating to disease management programs for certain Medicaid 
recipients.    
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter B, Chapter 32, Human Resources Code, 
is amended by adding Section 32.059 to read as follows:
	Sec. 32.059.  CONTRACTS FOR DISEASE MANAGEMENT 
PROGRAMS.  (a)  The department shall request contract proposals 
from providers of disease management programs to provide program 
services to recipients of medical assistance who:
		(1)  have a disease or other chronic health condition, 
such as heart disease, hemophilia, diabetes, respiratory illness, 
end-stage renal disease, HIV infection, or AIDS, that the 
department determines is a disease or condition that needs disease 
management; and
		(2)  are not eligible to receive those services under a 
Medicaid managed care plan.
	(b)  The department may contract with a public or private 
entity to:  
		(1)  write the requests for proposals;                                 
		(2)  determine how savings will be measured;                           
		(3)  identify populations that need disease 
management;              
		(4)  develop appropriate contracts; and                                
		(5)  assist the department in:                                         
			(A)  developing the content of disease management 
programs; and     
			(B)  obtaining funding for those programs.                            
	(c)  The department, by rule, shall prescribe the minimum 
requirements a provider of a disease management program must meet 
to be eligible to receive a contract under this section.  The 
provider must, at a minimum, be required to:
		(1)  use disease management approaches that are based 
on evidence-supported models, minimum standards of care, and 
clinical outcomes; and
		(2)  ensure that a recipient's primary care physician 
and other appropriate specialty physicians become directly 
involved in the disease management program through which the 
recipient receives services.
	(d)  The department may not award a contract for a disease 
management program under this section unless the contract includes 
a written guarantee of state savings on expenditures for the group 
of medical assistance recipients covered by the program.
	SECTION 2.  (a)  The Health and Human Services Commission 
shall conduct a study to analyze the potential for state savings 
through the use of disease management programs for recipients of 
medical assistance under Section 32.059, Human Resources Code, as 
added by this Act.  The study must identify the diseases and chronic 
health conditions that:
		(1)  result in the highest medical assistance 
expenditures by this state; and
		(2)  show the greatest potential for state savings on 
implementation of disease management programs.
	(b)  The commission shall consider the results of the study 
when requesting contract proposals under Section 32.059, Human 
Resources Code, as added by this Act.
	(c)  The commission may contract with a private entity to  
conduct a study and produce a report under this section.
	(d)  Not later than December 31, 2003, the commission shall 
complete the study required by this section and provide a report of 
its findings to the governor, the lieutenant governor, the speaker 
of the house of representatives, and the standing committees of the 
senate and house of representatives having jurisdiction over health 
and human services issues.
	SECTION 3.  If before implementing any provision of this Act 
a state agency determines that a waiver or authorization from a 
federal agency is necessary for implementation of that provision, 
the agency affected by the provision shall request the waiver or 
authorization and may delay implementing that provision until the 
waiver or authorization is granted.
	SECTION 4.  This Act takes effect immediately if it receives 
a vote of two-thirds of all the members elected to each house, as 
provided by Section 39, Article III, Texas Constitution.  If this 
Act does not receive the vote necessary for immediate effect, this 
Act takes effect September 1, 2003.