79R9412 T

By:  Delisi                                                       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.  The heading to Section 533.009, Government Code, 
is amended to read as follows:
	Sec. 533.009.  [SPECIAL] DISEASE MANAGEMENT.                  
	SECTION 2.  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, such as heart disease, respiratory illness, including 
asthma, diabetes, end-stage renal disease, HIV infection, or AIDS, 
[and] with respect to which the commission identifies populations 
for which disease management would be cost-effective.
	SECTION 3.  Section 32.059(c), Human Resources Code, as 
added by Chapter 208, Acts of the 78th Legislature, Regular 
Session, 2003, is amended to read as follows:
	(c)  The executive commissioner of the Health and Human 
Services Commission [department,] by rule[,] shall prescribe the 
minimum requirements managed care organizations under contract 
with the commission to provide health care services to recipients 
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;
		(3)  provide disease management services that have 
comparable performance measures for particular diseases as a 
provider of disease management programs under Chapter 32, Section 
32.059 Human Resources Code; and
		(4)  show evidence of managing complex diseases in the 
Medicaid and Medicare populations.
	(d)  A managed care health plan that develops and implements 
a disease management program shall coordinate care with the 
provider of disease management programs under Chapter 32, Section 
32.059 Human Resources Code.
	SECTION 4.  The executive commissioner of the Health and 
Human Services Commission shall, where it is determined to be more 
cost effective to the Medicaid program, utilize the services of a 
provider of disease management programs under Chapter 32, Section 
32.059 Human Resources Code. A recipient currently in a disease 
management program under Chapter 32, Section 32.059 Human Resources 
Code, that is in service area subject to a Medicaid managed care 
expansion has the option to remain enrolled in their current 
disease management program.
	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.