79R6152 KLA-F

By:  Guillen                                                      H.B. No. 1252



A BILL TO BE ENTITLED

AN ACT

relating to providing services for persons with chronic kidney 
disease under the medical assistance program.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 533.009(a), Government Code, is amended 
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 chronic health 
conditions, including [such as] heart disease, respiratory 
illness, including asthma, diabetes, chronic kidney disease and its 
medical complications, end-stage renal disease, HIV infection, and 
[or] AIDS, [and] with respect to which the commission identifies 
populations for which disease management would be cost-effective.
	SECTION 2.  Section 32.059, Human Resources Code, as added 
by Chapter 208, Acts of the 78th Legislature, Regular Session, 
2003, is amended by amending Subsection (a) and adding Subsection 
(b-1) to read as follows:
	(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 
other than chronic kidney disease, 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-1)  Notwithstanding Subsection (d), the department shall 
contract with providers of disease management programs to provide 
program services to recipients of medical assistance who have 
chronic kidney disease and who are not eligible to receive those 
services under a Medicaid managed care plan.
	SECTION 3.  Subchapter B, Chapter 32, Human Resources Code, 
is amended by adding Section 32.069 to read as follows:
	Sec. 32.069.  CHRONIC KIDNEY DISEASE MANAGEMENT INITIATIVE.  
(a)  The department shall develop a program to provide screening for 
and diagnosis and treatment of chronic kidney disease and its 
medical complications under the medical assistance program.  The 
program must:
		(1)  identify recipients of medical assistance who have 
been diagnosed with diabetes or hypertension or who have a family 
history of kidney disease;
		(2)  evaluate those recipients for kidney disease using 
diagnostic criteria described by Subsection (b); and
		(3)  classify recipients who are diagnosed under the 
program as having kidney disease as chronic kidney disease 
patients.
	(b)  In evaluating a recipient of medical assistance for 
kidney disease as required by Subsection (a)(2), a medical 
assistance provider must use generally recognized clinical 
practice guidelines and laboratory assessments that identify 
chronic kidney disease on the basis of impaired kidney function or 
the presence of kidney damage.
	(c)  The department shall provide diagnostic tests and 
health care services under the medical assistance program for a 
recipient who is classified as a chronic kidney disease patient if 
the recipient's physician certifies that the tests or services 
will:
		(1)  control factors that:                                             
			(A)  increase the recipient's risk for impaired 
kidney function or bone or cardiovascular disease associated with 
chronic kidney disease; or
			(B)  speed the progression of kidney disease 
toward the need for kidney replacement therapy; or
		(2)  improve the recipient's nutrition or correct 
anemia related to the chronic kidney disease.
	SECTION 4.  To provide disease management program services 
to persons with chronic kidney disease under the medical assistance 
program as required by Section 32.059(b-1), Human Resources Code, 
as added by this Act, the Health and Human Services Commission may:
		(1)  if possible, modify an existing contract between 
the commission and a provider of a disease management program under 
the medical assistance program; or
		(2)  enter into an additional contract with a provider 
described by Subdivision (1) of this section.
	SECTION 5.  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 6.  This Act takes effect September 1, 2005.