79R15359 UM-F


By:  Delisi                                                       H.B. No. 2472

Substitute the following for H.B. No. 2472:                                   

By:  Jackson                                                  C.S.H.B. No. 2472



A BILL TO BE ENTITLED

AN ACT

relating to disease management services under Medicaid managed 
care.        
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 533.009, Government Code, is amended by 
adding Subsection (f) to read as follows:
	(f)  The executive commissioner, by rule, shall prescribe 
the minimum requirements that a managed care organization, in 
providing a disease management program, must meet to be eligible to 
receive a contract under this section.  The managed care 
organization must, at a minimum, be required to:
		(1)  provide disease management services that have 
performance measures for particular diseases that are comparable to 
the relevant performance measures applicable to a provider of 
disease management services under Section 32.059, Human Resources 
Code, as added by Chapter 208, Acts of the 78th Legislature, Regular 
Session, 2003; and
		(2)  show evidence of managing complex diseases in the 
Medicaid population.
	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 (c) and adding Subsection 
(c-1) to read as follows:
	(c)  The executive commissioner of the Health and Human 
Services Commission [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 in the 
medical community, and clinical outcomes;  and
		(2)  ensure that a recipient's primary care physician 
and other appropriate specialty physicians, or registered nurses, 
advanced practice nurses, or physician assistants specified and 
directed or supervised in accordance with applicable law by the 
recipient's primary care physician or other appropriate specialty 
physicians, become directly involved in the disease management 
program through which the recipient receives services.
	(c-1)  A managed care health plan that develops and 
implements a disease management program under Section 533.009, 
Government Code, and a provider of a disease management program 
under this section shall coordinate during a transition period 
beneficiary care for patients that move from one disease management 
program to another program.
	SECTION 3.  The executive commissioner of the Health and 
Human Services Commission may use a provider of a disease 
management program under Section 32.059, Human Resources Code, as 
added by Chapter 208, Acts of the 78th Legislature, Regular 
Session, 2003, as amended by this Act, to provide disease 
management services if the executive commissioner determines that 
the use of that provider will be more cost-effective to the Medicaid 
program than using a provider of a disease management program under 
Section 533.009, Government Code, as amended by this Act.  A 
Medicaid recipient currently in a disease management program 
provided under Section 32.059, Human Resources Code, as added by 
Chapter 208, Acts of the 78th Legislature, Regular Session, 2003, 
in a service area that is subject to a Medicaid managed care 
expansion may remain enrolled in the recipient's current disease 
management program if the executive commissioner determines that 
allowing those recipients to remain is cost-effective.
	SECTION 4.  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 5.  This Act takes effect September 1, 2005.