Sec. 1551.219. DISEASE MANAGEMENT SERVICES. (a) In this section, "disease management services" means services to assist an individual manage a disease or other chronic health condition, such as heart disease, diabetes, respiratory illness, end-stage renal disease, HIV infection, or AIDS, and with respect to which the board of trustees identifies populations requiring disease management.
(b) A group health benefit plan offered under the group benefits program must provide disease management services or coverage for disease management services in the manner required by the board of trustees, including:
(1) patient self-management education;
(2) provider education;
(3) evidence-based models and minimum standards of care;
(4) standardized protocols and participation criteria; and
(5) physician-directed or physician-supervised care.
Added by Acts 2003, 78th Leg., ch. 589, Sec. 3, eff. June 20, 2003.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle H - Health Benefits and Other Coverages for Governmental Employees
Chapter 1551 - Texas Employees Group Benefits Act
Section 1551.201. Establishment
Section 1551.2011. Employee Awareness and Education
Section 1551.202. Authority to Define Basic Coverages
Section 1551.203. Authority to Define Optional Coverages
Section 1551.204. Authority to Define Voluntary Coverages
Section 1551.206. Cafeteria Plan
Section 1551.207. Premium Conversion Benefit Portion of Cafeteria Plan
Section 1551.208. Determination to Self-Fund
Section 1551.209. Coverage Exempt From Insurance Law
Section 1551.210. Actuarial Advice for Self-Funded Coverage
Section 1551.211. Contingency Reserve Fund for Self-Funded Coverage
Section 1551.212. Firms to Administer Self-Funded Coverage
Section 1551.213. Bids for Purchased Coverage
Section 1551.214. Selection of Bids for Purchased Coverage
Section 1551.215. Accounting by Carrier Providing Purchased Coverage
Section 1551.216. Special Contingency Reserve
Section 1551.217. Use of Employee's Salary in Computation of Premium or Coverage
Section 1551.218. Prior Authorization for Certain Drugs
Section 1551.219. Disease Management Services
Section 1551.220. Beneficiary Causing Death of Participant or Beneficiary of Participant
Section 1551.222. Incentive Payments
Section 1551.224. Mail Order Requirement for Prescription Drug Coverage Prohibited
Section 1551.225. Bariatric Surgery Coverage
Section 1551.226. Tobacco Cessation Coverage
Section 1551.227. Tricare Military Health System Supplemental Plan
Section 1551.228. Emergency Care Payments
Section 1551.229. Out-of-Network Facility-Based Provider Payments
Section 1551.230. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments