Texas Human Resources Code - Section 32.057. Contracts For Disease Management Programs
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Texas Laws > Human Resources Code > Texas Human Resources Code - Section 32.057. Contracts For Disease Management Programs
Section: 32.051 32.052 32.053. PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY
(PACE). (a) The department, as a part of the medical assistance
program, shall develop and implement a program of all-inclusive
care for the elderly (PACE) in accordance with Section 4802 of the
Balanced Budget Act of 1997 (Pub. L. No. 105-33), as amended. The
department shall provide medical assistance to a participant in the
PACE program in the manner and to the extent authorized by federal
(b) The department shall adopt rules as necessary to
implement this section. In adopting rules, the department shall:
(1) use the Bienvivir Senior Health Services of El
Paso initiative as a model for the program; and
(2) ensure that a person is not required to hold a
certificate of authority as a health maintenance organization under
the Texas Health Maintenance Organization Act (Chapter 20A,
Vernon's Texas Insurance Code) to provide services under the PACE
(c) The department may not contract with a person to provide
services under the PACE program unless the person:
(1) purchases reinsurance in an amount determined by
the department that is sufficient to ensure the person's continued
(2) has the financial resources sufficient to cover
expenses in the event of the person's insolvency.
(d) To demonstrate sufficiency of financial resources for
purposes of Subsection (c)(2), a person may use cash reserves, a
letter of credit, a guarantee of a company affiliated with the
person, or a combination of those arrangements. The amount of a
person's financial arrangement must be at least equal to the sum of:
(1) the total capitation revenue for one month; and
(2) the average monthly payment of operating expenses.
(e) The department, with the cooperation of the Texas
Department on Aging and area agencies on aging, shall develop and
implement a coordinated plan to promote PACE program sites
operating under this section. The department shall adopt policies
and procedures to ensure that caseworkers and any other appropriate
department staff discuss the benefits of participating in the PACE
program with long-term care clients.
Added by Acts 2001, 77th Leg., ch. 170, § 1, eff. Sept 32.054 32.055 32.0551 32.056 32.057 32.058 32.059 32.060 32.060 32.061 32.063 32.064
§ 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;
(2) are not eligible to receive those services under a
Medicaid managed care plan.
(b) The department may contract with a public or private
(1) write the requests for proposals;
(2) determine how savings will be measured;
(3) identify populations that need disease
(4) develop appropriate contracts; and
(5) assist the department in:
(A) developing the content of disease management
(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
(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