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Texas Statutes (Last Updated: January 4, 2014) |
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GOVERNMENT CODE |
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Title 4. EXECUTIVE BRANCH |
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Subtitle I. HEALTH AND HUMAN SERVICES |
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Chapter 533. IMPLEMENTATION OF MEDICAID MANAGED CARE PROGRAM |
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Subchapter D. INTEGRATED CARE MANAGEMENT MODEL |
Sec. 533.061. INTEGRATED CARE MANAGEMENT MODEL
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(a) The executive commissioner, by rule, shall develop an integrated care management model of Medicaid managed care. The "integrated care management model" is a noncapitated primary care case management model of Medicaid managed care with enhanced components to:
(1) improve patient health and social outcomes;
(2) improve access to care;
(3) constrain health care costs; and
(4) integrate the spectrum of acute care and long-term care services and supports.
(b) In developing the integrated care management model, the executive commissioner shall ensure that the integrated care management model utilizes managed care principles and strategies to assure proper utilization of acute care and long-term care services and supports. The components of the model must include:
(1) the assignment of recipients to a medical home;
(2) utilization management to assure appropriate access and utilization of services, including prescription drugs;
(3) health risk or functional needs assessment;
(4) a method for reporting to medical homes and other appropriate health care providers on the utilization by recipients of health care services and the associated cost of utilization of those services;
(5) mechanisms to reduce inappropriate emergency department utilization by recipients, including the provision of after-hours primary care;
(6) mechanisms that ensure a robust system of care coordination for assessing, planning, coordinating, and monitoring recipients with complex, chronic, or high-cost health care or social support needs, including attendant care and other services needed to remain in the community;
(7) implementation of a comprehensive, community-based initiative to educate recipients about effective use of the health care delivery system;
(8) strategies to prevent or delay institutionalization of recipients through the effective utilization of home and community-based support services; and
(9) any other components the executive commissioner determines will improve a recipient's health outcome and are cost-effective.
(c) For purposes of this chapter, the integrated care management model is a managed care plan.