Sec. 1575.164. 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 Teacher Retirement System of Texas identifies populations requiring disease management.
(b) A health benefit plan provided under this chapter, other than a Medicare Advantage plan or a Medicare prescription drug plan, must provide disease management services or coverage for disease management services in the manner required by the Teacher Retirement System of Texas, 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. 4, eff. June 20, 2003.
Renumbered from Insurance Code, Section 1575.162 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(62), eff. September 1, 2005.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 16, eff. September 1, 2017.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle H - Health Benefits and Other Coverages for Governmental Employees
Chapter 1575 - Texas Public School Employees Group Benefits Program
Subchapter D. Coverages and Participation
Section 1575.151. Types of Coverages
Section 1575.152. Health Benefit Plan Must Cover Preexisting Conditions
Section 1575.153. Health Benefit Plan Coverage for Retirees
Section 1575.155. Coverage for Dependents of Retiree
Section 1575.156. Coverage for Surviving Spouse or Dependents of Surviving Spouse
Section 1575.157. Coverage for Surviving Dependent Child
Section 1575.158. Group Health Benefit Plans
Section 1575.1582. Eligibility for Group Health Benefit Plans
Section 1575.159. Coverage for Prostate-Specific Antigen Test
Section 1575.160. Group Life or Accidental Death and Dismemberment Insurance: Payment of Claim
Section 1575.161. Enrollment Periods
Section 1575.162. Special Enrollments
Section 1575.164. Disease Management Services
Section 1575.170. Prior Authorization for Certain Drugs
Section 1575.171. Emergency Care Payments
Section 1575.172. Out-of-Network Facility-Based Provider Payments
Section 1575.173. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments