Texas § HR.32.057 - CONTRACTS FOR DISEASE MANAGEMENT PROGRAMS

§ HR.32.057. CONTRACTS FOR DISEASE MANAGEMENT PROGRAMS

CONTRACTS FOR DISEASE MANAGEMENT PROGRAMS. (a) The commission 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 commission 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 commission 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 commission in: (A) developing the content of disease management programs; and (B) obtaining funding for those programs. (c) The executive commissioner 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 540.0708 , 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 commission 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 commission 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(a)(2)), 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 commission under this section, the commission 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 commission, 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 commission under Subdivision (1) to participate in the research programs described by Subdivision (1). Added by Acts 2003, 78th Leg., ch. 208, Sec. 1, eff. June 16, 2003. Amended by: Acts 2005, 79th Leg., Ch. 349 (S.B. 1188 ), Sec. 19(b), eff. September 1, 2005. Renumbered from Human Resources Code, Section 32.059 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018 ), Sec. 23.001 (59), eff. September 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 1047 (H.B. 1252 ), Sec. 2, eff. September 1, 2005. Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219 ), Sec. 4.132, eff. April 2, 2015. Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 2.86, eff. April 1, 2025.