Amend SB 1188 on third reading by adding the following 
appropriately numbered SECTION to the bill and renumbering 
subsequent SECTIONS accordingly:
	SECTION     .  (a) Chapter 533, Government Code, is amended by 
adding Subchapter D to read as follows:
SUBCHAPTER D. INTEGRATED CARE MANAGEMENT MODEL
Sec. 533.061. INTEGRATED CARE MANAGEMENT MODEL. (a) The executive commissioner, by rule, shall develop an integrated care management model of Medicaid managed care. The "integrated care management model" is a noncapitated primary care case management model of Medicaid managed care with enhanced components to: (1) improve patient health and social outcomes; (2) improve access to care; (3) constrain health care costs; and (4) integrate the spectrum of acute care and long-term care services and supports. (b) In developing the integrated care management model, the executive commissioner shall ensure that the integrated care management model utilizes managed care principles and strategies to assure proper utilization of acute care and long-term care services and supports. The components of the model must include: (1) the assignment of recipients to a medical home; (2) utilization management to assure appropriate access and utilization of services, including prescription drugs; (3) health risk or functional needs assessment; (4) a method for reporting to medical homes and other appropriate health care providers on the utilization by recipients of health care services and the associated cost of utilization of those services; (5) mechanisms to reduce inappropriate emergency department utilization by recipients, including the provision of after-hours primary care; (6) mechanisms that ensure a robust system of care coordination for assessing, planning, coordinating, and monitoring recipients with complex, chronic, or high-cost health care or social support needs, including attendant care and other services needed to remain in the community; (7) implementation of a comprehensive, community-based initiative to educate recipients about effective use of the health care delivery system; (8) strategies to prevent or delay institutionalization of recipients through the effective utilization of home and community-based support services; and (9) any other components the executive commissioner determines will improve a recipient's health outcome and are cost-effective. (c) For purposes of this chapter, the integrated care management model is a managed care plan. Sec. 533.062. CONTRACTING FOR INTEGRATED CARE MANAGEMENT. (a) The commission may contract with one or more administrative services organizations to perform the coordination of care and other services and functions of the integrated care management model developed under Section 533.061. (b) The commission may require that each administrative services organization contracting with the commission under this section assume responsibility for exceeding administrative costs and not meeting performance standards in connection with the provision of acute care and long-term care services and supports under the terms of the contract. (c) The commission may include in a contract awarded under this section a written guarantee of state savings on Medicaid expenditures for recipients receiving services provided under the integrated care management model developed under Section 533.061. (d) The commission may require that each administrative services organization contracting with the commission under this section establish pay-for-performance incentives for providers to improve patient outcomes. (e) In this section, "administrative services organization" means an entity that performs administrative and management functions, such as the development of a physician and provider network, care coordination, service coordination, utilization review and management, quality management, and patient and provider education, for a noncapitated system of health care services, medical services, or long-term care services and supports. Sec. 533.063. STATEWIDE INTEGRATED CARE MANAGEMENT ADVISORY COMMITTEE. (a) The executive commissioner may appoint an advisory committee to assist the executive commissioner in the development and implementation of the integrated care management model. (b) The advisory committee is subject to Chapter 551. (b) The Health and Human Services Commission shall require each administrative services organization contracting with the commission to perform services under Section 533.062, Government Code, as added by this section, to coordinate with, use, and otherwise interface with the fee-for-service claims payment contractor operating in this state on August 31, 2005, until the date the claims payment contract expires, subject to renewal of the contract. (c) The commission may require each administrative services organization contracting with the commission to perform services under Section 533.062, Government Code, as added by this section, to incorporate disease management into the integrated care management model established under Section 533.061, Government Code, as added by this section, utilizing the Medicaid disease management contractor operating in this state on November 1, 2004, until the date the disease management contract expires, subject to renewal of the contract. (d) If any provision of this section conflicts with a statute enacted by the 79th Legislature, Regular Session, 2005, the provision of this section controls.