78R9235 KEG-D
By: Delisi H.B. No. 727
Substitute the following for H.B. No. 727:
By: Gutierrez C.S.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, 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.