78R5425 DLF-D
By: Delisi H.B. No. 1735
A BILL TO BE ENTITLED
AN ACT
relating to disease management services under certain state-funded
or state-administered health plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 62, Health and Safety
Code, is amended by adding Section 62.159 to read as follows:
Sec. 62.159. DISEASE MANAGEMENT SERVICES. (a) In this
section, "disease management services" means services to assist a
child manage a disease or other chronic health condition such as
heart disease, diabetes, respiratory illness, end-stage renal
disease, HIV infection, or AIDS.
(b) The child health plan must provide disease management
services or coverage for disease management services in the manner
required by the commission.
(c) The commission shall study the benefits and costs of
applying disease management principles in the delivery of services
to children with chronic health conditions. The commission shall
report the results of the study to the governor, lieutenant
governor, and speaker of the house of representatives not later
than December 1, 2004. In conducting the study, the commission
shall evaluate the effectiveness of those principles in:
(1) reducing long-term health care costs under the
child health plan;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns under the child
health plan.
(d) The commission may conduct the study under Subsection
(c) in conjunction with an academic center.
(e) Subsections (c) and (d) and this subsection expire
January 1, 2005.
SECTION 2. Subchapter E, Chapter 3, Insurance Code, is
amended by adding Article 3.50-7B to read as follows:
Art. 3.50-7B. DISEASE MANAGEMENT SERVICES. (a) In this
article, "disease management services" means services to assist an
individual manage a disease or other chronic health condition such
as heart disease, diabetes, respiratory illness, end-stage renal
disease, HIV infection, or AIDS.
(b) A health coverage plan provided under the uniform group
coverage program established under Article 3.50-7 of this code must
provide disease management services or coverage for disease
management services in the manner required by the Teacher
Retirement System of Texas.
(c) The Teacher Retirement System of Texas shall study the
benefits and costs of applying disease management principles in the
delivery of services to uniform group coverage program participants
with chronic health conditions. The system shall report the
results of the study to the governor, lieutenant governor, and
speaker of the house of representatives not later than December 1,
2004. In conducting the study, the system shall evaluate the
effectiveness of those principles in:
(1) reducing long-term health care costs under the
uniform group coverage program;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns under the uniform
group coverage program.
(d) The Teacher Retirement System of Texas may conduct the
study under Subsection (c) of this article in conjunction with an
academic center.
(e) Subsections (c) and (d) of this article and this
subsection expire January 1, 2005.
SECTION 3. Subchapter E, Chapter 1551, Insurance Code, as
effective June 1, 2003, is amended by adding Section 1551.219 to
read as follows:
Sec. 1551.219. DISEASE MANAGEMENT SERVICES. (a) In this
section, "disease management services" means services to assist an
individual manage a disease or other chronic health condition such
as heart disease, diabetes, respiratory illness, end-stage renal
disease, HIV infection, or AIDS.
(b) A group health benefit plan offered under the group
benefits program must provide disease management services or
coverage for disease management services in the manner required by
the board of trustees.
(c) The board of trustees shall study the benefits and costs
of applying disease management principles in the delivery of
services to participants in the group benefits program. The board
shall report the results of the study to the governor, lieutenant
governor, and speaker of the house of representatives not later
than December 1, 2004. In conducting the study, the board shall
evaluate the effectiveness of those principles in:
(1) reducing long-term health care costs under the
group benefits program;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns under the group
benefits program.
(d) The board of trustees may conduct the study under
Subsection (c) in conjunction with an academic center.
(e) Subsections (c) and (d) and this subsection expire
January 1, 2005.
SECTION 4. Subchapter D, Chapter 1575, Insurance Code, as
effective June 1, 2003, is amended by adding Section 1575.162 to
read as follows:
Sec. 1575.162. DISEASE MANAGEMENT SERVICES. (a) In this
section, "disease management services" means services to assist an
individual manage a disease or other chronic health condition such
as heart disease, diabetes, respiratory illness, end-stage renal
disease, HIV infection, or AIDS.
(b) A health benefit plan provided under this chapter must
provide disease management services or coverage for disease
management services in the manner required by the Teacher
Retirement System of Texas.
(c) The Teacher Retirement System of Texas shall study the
benefits and costs of applying disease management principles in the
delivery of services to participants in the group program. The
system shall report the results of the study to the governor,
lieutenant governor, and speaker of the house of representatives
not later than December 1, 2004. In conducting the study, the system
shall evaluate the effectiveness of those principles in:
(1) reducing long-term health care costs under the
group program;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns under the group
program.
(d) The Teacher Retirement System of Texas may conduct the
study under Subsection (c) in conjunction with an academic center.
(e) Subsections (c) and (d) and this subsection expire
January 1, 2005.
SECTION 5. Subchapter C, Chapter 1601, Insurance Code, as
effective June 1, 2003, is amended by adding Section 1601.110 to
read as follows:
Sec. 1601.110. DISEASE MANAGEMENT SERVICES. (a) In this
section, "disease management services" means services to assist an
individual manage a disease or other chronic health condition such
as heart disease, diabetes, respiratory illness, end-stage renal
disease, HIV infection, or AIDS.
(b) A health benefit plan provided under this chapter must
provide disease management services or coverage for disease
management services in the manner required by the governing board
of a system.
(c) The governing board of each system shall study the
benefits and costs of applying disease management principles in the
delivery of services to participants in the uniform program
provided by the system. The board shall report the results of the
study to the governor, lieutenant governor, and speaker of the
house of representatives not later than December 1, 2004. In
conducting the study, the board shall evaluate the effectiveness of
those principles in:
(1) reducing long-term health care costs under the
uniform program provided by the system;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns under the uniform
program provided by the system.
(d) The governing board of a system may conduct the study
under Subsection (c) in conjunction with an academic center.
(e) Subsections (c) and (d) and this subsection expire
January 1, 2005.
SECTION 6. Subchapter E, Chapter 501, Government Code, is
amended by adding Section 501.149 to read as follows:
Sec. 501.149. DISEASE MANAGEMENT SERVICES. (a) In this
section, "disease management services" means services to assist a
person manage a disease or other chronic health condition such as
heart disease, diabetes, respiratory illness, end-stage renal
disease, HIV infection, or AIDS.
(b) A managed health care plan must provide disease
management services in the manner required by the committee.
(c) The committee shall study the benefits and costs of
applying disease management principles in the delivery of services
to participants in a managed health care plan. The committee shall
report the results of the study to the governor, lieutenant
governor, and speaker of the house of representatives not later
than December 1, 2004. In conducting the study, the committee shall
evaluate the effectiveness of those principles in:
(1) reducing long-term health care costs under the
managed health care plan;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns under the managed
health care plan.
(d) The committee may conduct the study under Subsection (c)
in conjunction with an academic center.
(e) Subsections (c) and (d) and this subsection expire
January 1, 2005.
SECTION 7. Section 533.009, Government Code, is amended by
amending Subsections (a) and (b) and adding Subsection (d) to read
as follows:
(a) The commission shall ensure that managed care
organizations under contract with the commission to provide health
care services to recipients develop and implement special disease
management programs to manage a disease or other [address] chronic
health condition [conditions], such as heart disease, respiratory
illness including asthma, [and] diabetes, end-stage renal disease,
HIV infection, or AIDS, and use outcome measures to assess the
programs.
(b) The commission shall study the benefits and costs of
applying disease management principles in the delivery of Medicaid
managed care services to recipients with chronic health conditions.
The commission shall report the results of the study to the
governor, lieutenant governor, and speaker of the house of
representatives not later than December 1, 2004. In conducting the
study, the commission shall evaluate the effectiveness of those
principles in:
(1) reducing long-term health care costs under the
Medicaid managed care program;
(2) improving patient care, including the
coordination of that care; and
(3) improving utilization patterns of recipients.
(d) Subsections (b) and (c) and this subsection expire
January 1, 2005.
SECTION 8. The state child health plan, each health
coverage plan provided under Article 3.50-7, Insurance Code, each
health benefit plan provided under Chapter 1551, 1575, or 1601,
Insurance Code, the managed health care plan provided under
Subchapter E, Chapter 501, Government Code, and a Medicaid managed
care plan subject to Chapter 533, Government Code, shall provide
disease management services or coverage for disease management
services in accordance with this Act as soon as practicable after
the effective date of this Act, but not later than January 1, 2004.
SECTION 9. 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.