Citations Affected: IC 12-15-12-19; IC 16-38-6.
Synopsis: Chronic disease management and registry. Removes
exemption of the risk-based managed care program from the disease
management program. Allows the state department of health to add
chronic diseases to the chronic disease registry by administrative rule.
Adds public and private third party payers as: (1) persons to be used by
the office of Medicaid policy and planning in implementing a disease
management program; and (2) persons that may report chronic disease
cases for the chronic disease registry. (The introduced version of this
bill was prepared by the select joint commission on Medicaid
oversight.)
Effective: July 1, 2004.
November 18, 2003, read first time and referred to Committee on Health and Provider
Services.
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
SECTION 1. IC 12-15-12-19, AS AMENDED BY P.L.212-2003,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2004]: Sec. 19. (a) This section applies to an individual who
(1) is a Medicaid recipient. and
(2) is not enrolled in the risk-based managed care program.
(b) Subject to subsection (c), the office shall develop the following
programs regarding individuals described in subsection (a):
(1) A disease management program for recipients with any of the
following chronic diseases:
(A) Asthma.
(B) Diabetes.
(C) Congestive heart failure or coronary heart disease.
(D) Hypertension.
(2) A case management program for recipients described in
subsection (a) who are at high risk of chronic disease, that is
based on a combination of cost measures, clinical measures, and
health outcomes identified and developed by the office with input
and guidance from the state department of health and other
experts in health care case management or disease management
programs.
(c) The office shall implement:
(1) a pilot program for at least two (2) of the diseases listed in
subsection (b) not later than July 1, 2003; and
(2) a statewide chronic disease program as soon as practicable
after the office has done the following:
(A) Evaluated a pilot program described in subdivision (1).
(B) Made any necessary changes in the program based on the
evaluation performed under clause (A).
(d) The office shall develop and implement a program required
under this section in cooperation with the state department of health
and shall use the following health care providers persons to the extent
possible:
(1) Community health centers.
(2) Federally qualified health centers (as defined in 42 U.S.C.
1396d(l)(2)(B)).
(3) Rural health clinics (as defined in 42 U.S.C. 1396d(l)(1)).
(4) Local health departments.
(5) Hospitals.
(6) Public and private third party payers.
(e) The office may contract with an outside vendor or vendors to
assist in the development and implementation of the programs required
under this section.
(f) The office and the state department of health shall provide the
select joint commission on Medicaid oversight established by
IC 2-5-26-3 with an evaluation and recommendations on the costs,
benefits, and health outcomes of the pilot programs required under this
section. The evaluations required under this subsection must be
provided not more than twelve (12) months after the implementation
date of the pilot programs.
(g) The office and the state department of health shall report to the
select joint commission on Medicaid oversight established by
IC 2-5-26-3 not later than November 1 of each year regarding the
programs developed under this section.
SECTION 2. IC 16-38-6-1, AS ADDED BY P.L.212-2003,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2004]: Sec. 1. As used in this chapter, "chronic disease"
means one (1) of the following conditions:
(1) Asthma.
(2) Diabetes.