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Texas Human Resources Code - Section 32.057. Contracts For Disease Management Programs

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§ 32.057. CONTRACTS FOR DISEASE MANAGEMENT PROGRAMS.  (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, 
such as heart disease, hemophilia, chronic kidney disease and its 
medical complications, 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)  The department may contract with a public or private 
entity to:         
		(1)  write the requests for proposals;                                        
		(2)  determine how savings will be measured;                                  
		(3)  identify populations that need disease 
management;                     
		(4)  develop appropriate contracts;  and                                      
		(5)  assist the department in:                                                
			(A)  developing the content of disease management 
programs;  and           
			(B)  obtaining funding for those programs.                                   
	(c)  The executive commissioner of the Health and Human 
Services Commission, 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, 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.
	(d)  The department may not award a contract for a disease 
management program under this section unless the contract includes 
a written guarantee of state savings on expenditures for the group 
of medical assistance recipients covered by the program.
	(e)  The department may enter into a contract under this 
section with a comprehensive hemophilia diagnostic treatment 
center that receives funding through a maternal and child health 
services block grant under Section 501(a)(2), Social Security Act 
(42 U.S.C. Section 701), and the center shall be considered a 
disease management provider.
	(f)  Directly or through a provider of a disease management 
program that enters into a contract with the department under this 
section, the department shall, as appropriate and to the extent 
possible without cost to the state:
		(1)  identify recipients of medical assistance under 
this chapter or, at the discretion of the department, enrollees in 
the child health plan under Chapter 62, Health and Safety Code, who 
are eligible to participate in federally funded disease management 
research programs operated by research-based disease management 
providers;  and
		(2)  assist and refer eligible persons identified by 
the department under Subdivision (1) to participate in the research 
programs described by Subdivision (1).

Added by Acts 2003, 78th Leg., ch. 208, § 1, eff. June 16, 2003.  
Amended by Acts 2005, 79th Leg., ch. 349, § 19(b), eff. Sept. 1, 
2005;  Acts 2005, 79th Leg., ch. 1047, § 2, eff. Sept. 1, 2005.  
Renumbered from V.T.C.A., Human Resources Code § 32.059 by Acts 
2005, 79th Leg., ch. 728, § 23.001(59), eff. Sept. 1, 2005.

Last modified: August 11, 2007