50 State Summary of Disease Management Laws
Updated Oct., 2007
States across the country are implementing or expanding disease management programs to contain costs while at the same time improve health care quality and patient outcomes. While disease management dates back to the mid-1990s, a number of states have recently taken steps to set up or expand their existing programs.
In addition to integrating disease management into Medicaid programs, states are also encouraging state employees' benefits plans and some private health insurers to incorporate disease management principles in their health benefit plans.
The chart below summarizes state laws that specifically address disease management in 26 states. (Arizona, California, Colorado, Connecticut, Delaware, Florida, Illinois, Indiana, Iowa, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Rhode Island, South Dakota, Texas, Vermont and Washington) In addition to the states listed, at least 9 other states (Alabama, Arkansas, Georgia, Maryland, Oregon, South Carolina, Tennessee, Utah and West Virginia) have some type of disease management program not established through legislation.
A | C | D | F | G | I | L | M | N | O | R | S | T | V | W
| State |
Description of Disease Management Law |
| Arizona |
Ariz. Chapter No. 90 (2005) Establishes the Chronic Disease and Pain Management Task Force to review acute and chronic pain management education provided by professional licensing boards and analyze available information resources. |
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California
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Cal. Stats., Chap. 879 (2003) requires the Department of Health Services to develop a brochure to educate pregnant women and new parents about issues related to maintaining a healthy lifestyle and preventing chronic diseases in pregnant women, new mothers, and young children. The brochure will be made available to individuals who contact the BabyCal program and to each participant in the Access for Infants and Mothers program, and will also be included on the department's web site.
Cal. Health and Safety Code § 1399.900 et seq. (2004) defines disease management organizations (DMO's) and disease management programs and services. Requires DMO's to obtain physician prior authorization before providing services or dispensing medication. Prohibits DMOs from using medical information to solicit to, or to offer for sale any products or services and specifies that DMOs are subject to Confidentiality of Medical Information Act.
Cal. Health and Safety Code § 104141 et seq. (2004) creates the Heart Disease and Stroke Prevention and Treatment Task Force within the Department of Health Services to perform certain duties relating to cardiovascular and stroke prevention by the creation of a Heart Disease and Stroke Prevention and Treatment State Master Plan.
Cal. Health and Safety Code § 104316 et seq. (2004) requires the Department of Health Services to administer funds to organizations that propose promising and innovative asthma interventions - such as disease management - that are scientifically based and target both child and adult asthmatics.
Cal. Health and Safety Code § 127670 et seq. (2004) convenes the California Health Care Quality Improvement and Cost Containment Commission, comprised of one expert in disease management, to issue a report by January 1, 2005. The report will make recommendations for quality improvements and cost containment, including the use of disease management.
Cal. Wel. & Inst. Code § 14105.436 (2004) directs all pharmaceutical manufacturers to provide a state rebate for any products added to the Medi-Cal list of contract drugs and states that the negotiations shall take into account cost savings offers, such as disease management programs.
Cal. Wel. & Inst. Code § 14132.27 (2004) directs the Medi-Cal program to apply for a federal waiver to test the efficacy of a disease management program. Eligibility for the disease management waiver is limited to persons with specific chronic conditions.
Cal. Resol., Chap. 151 (2006) establishes a Legislative Task Force on Diabetes and Obesity to study the factors contributing to the high rates of diabetes and obesity in Latinos, African-Americans, Asian Pacific Islanders, and Native Americans in this country. The task force shall produce a report containing recommendations regarding ways to reduce the incidence in these ethnic groups.
Cal. Health and Safety Code § 130200 et seq. establishes a Parkinson's Disease Community Outreach, Diagnosis, and Treatment Project that includes disease management training and disease management outreach services targeting Parkinson's patients and caregivers from communities of color "that would not otherwise have access to those services." |
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Colorado |
Colo. Rev. Stat. § 26-4-408 (2003) requires the state to implement drug utilization mechanisms for the medical assistance program.
Colo. Rev. Stat. § 25.5-5-316 (Formerly § 26-4-408.5) authorizes implementation of disease management programs for fee-for-service and primary care physician program recipients. Programs are designed to achieve appropriate use of services or prescription drugs for Medicaid recipients with a particular chronic disease. The program targets recipients who are receiving more services or prescription drugs than are expected. |
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Connecticut |
2003 Conn. Acts, S.A. 03-14 directs the Department of Public Health to develop a comprehensive heart disease and stroke prevention plan by June, 2004.
2003 Conn. Acts, S.A. 03-3 directs the Commissioner of Social Services to design and implement a disease management initiative, and permits the Commissioner to contract with disease management entities. Requires an annual report to the General Assembly.
Conn. Public Act No. 209 Sub. House Bill 6688 (2005) establishes a pilot program comprised of 150 elderly people who receive personalized/home health care as an alternative to institutionalization; care providers may be nonspousal relatives. Program will study the cost effectiveness of this alternative. |
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Delaware
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HJR 10 (2003) authorizes Delaware's state Health Care Commission to examine chronic illness and disease management strategies. The task force is required to evaluate the health benefits associated with these programs. |
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Florida
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Fla. Stat. § 409.91188 (2002) directs the Agency for Health Care Administration to seek all necessary federal waivers to allow participation in the Medipass HIV disease management program for Medicare beneficiaries who also qualify for Medicaid benefits (e.g., prescription drugs) that are not covered by Medicaid.
Fla. Stat. § 409.912(13) (2002) directs the Agency for Health Care Administration to purchase goods and services for Medicaid recipients in a cost effective manner. The Agency must identify utilization patterns in the Medicaid program that are not cost effective or medically appropriate and implement methods, such as disease management initiatives, to improve health outcomes and reduce overall costs. The agency is also directed to develop educational interventions to promote appropriate use of medications for beneficiaries and providers.
Fla. Stat. § 627.6489 (2003) permits the Florida Comprehensive Health Association to contract with insurers to provide disease management services for insurers that elect to participate in the association's disease management program. |
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Georgia |
GA Act no. 573 ( 2006) (Formerly HB 1066) relates to control of hazardous conditions, preventable disease, and systems for newborn screening. |
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Illinois
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Ill. Rev. Stat. ch. 305, § 5/24 (2004) establishes a pilot project to study patient outcomes for patients in the Medicaid program with certain chronic diseases, such as diabetes, congestive heart failure, and chronic obstructive pulmonary disease. The disease management pilot project is directed to examine health outcomes and the impact on costs in the medical assistance program.
Ill. Rev. Stat. ch. 20 § 1705/71 (2004) establishes a three-year pilot program to integrate disease management guidelines into behavioral health care services for individuals receiving partial or full funding from federal and state sources. The Department is directed to contract with a provider serving Peoria County.
Ill. Rev. Stat. ch. 20 § 2310/338 (2004) requires the Department of Public Health to establish an asthma prevention and control program to provide leadership in Illinois for and coordination of asthma prevention and intervention activities. Includes monitoring of asthma prevalence, education and training of health care professionals.
Ill. Rev. Stat. ch. 210 § 3/30 et seq. (2004) authorizes alternative health care models, including an Alzheimer's disease management center. In addition to developing and implementing an ongoing treatment plan for residents, the center also provides education and support for residents and caregivers.
Public Act No. 94-328 (2005) establishes a pediatric asthma initiative to evaluate the current standards of care for Medicaid patients and make recommendations on how those programs can be improved. The Department of Public Aid must create a comprehensive disease management model for asthma patients, including the early detection, treatment of, and control of the disease. A pilot program will test the effectiveness of the plan and seek to maximize collaboration between state and private health care agencies. |
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Indiana |
Ind. Code § 12-15-12-19 (2004) amends Indiana's current disease management program to include hypertension and remove HIV/AIDS. The act directs the creation of a pilot program to cover two of the following diseases: hypertension, asthma, diabetes, and congestive heart failure.
Ind. Code § 27-8-10-3.5 (2004) allows the Indiana Comprehensive Health Insurance Association to approve and implement a chronic disease management and pharmaceutical management program.
Ind. Public Law No. 48 (2005) adds kidney disease to the Chronic Disease Management Program and the chronic disease registry.
Ind. Code § 16-38-6 authorizes the creation of a chronic disease registry to record cases of asthma, diabetes, congestive heart failure or coronary heart disease and hypertension. The registry will compile data and help to develop cost and clinical measures for these diseases. |
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Iowa |
2003 Iowa Acts, Chap. 112 (Formerly HF 619) authorizes the Department of Human Services to create a disease management pilot program for certain individuals in the state's medical assistance program. The Department will issue an RFP for vendors to manage individuals with diseases such as congestive heart failure, diabetes and asthma.
2003 Iowa Acts, Chap. 179 (Formerly SF 458)directs the chronic care consortium to conduct a chronic disease management pilot project for a select number of people in the medical assistance program. |
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Louisiana
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La. Rev. Stat. Ann. 40 § 1299.90.2 (2004) directs the Women's Health Program in the Department of Health and Hospitals to provide a statewide Breast Cancer Control Program. The program is funded by the Health Excellence Fund which supports comprehensive chronic disease management services.
La. Rev. Stat. Ann. 39 § 98.4 (2004) requires tobacco settlement proceeds be used for certain activities, such as comprehensive chronic disease management. |
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Maine
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Me. Public Law Chap. 430 (2003) defines pharmacy benefits management to include services such as disease management programs, mail service pharmacy and clinical formulary development and management services.
Me. Public Law Chap. 469 (2003) directs Dirigo Health to promote quality improvement, disease prevention and disease management. Authorizes Dirigo Health to include disease management and cost-containment provisions in the contracts with participating health insurance carriers, and authorizes Dirigo Health to collect payments from participating employers and enrollees to cover the cost of disease management.
Me. Rev. Stat. Ann. tit. 24-A § 6971 (2003) directs Dirigo Health to establish the Dirigo Health High-Risk Pool and develop and implement appropriate disease management protocols. Dirigo Health may contract separately with another entity for disease management services or provide those services directly through Dirigo Health. |
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Minnesota |
Minn. Stat. § 62E. 10 (2003) creates a Comprehensive Health Association comprised of all insurers, self-insurers and health maintenance organizations. The Association is directed to develop a focused chronic disease management and case management program.
Minn. Chapter No. 268 (2003) (Formerly HB2762, Companion SB2613) relates to the Minnesota Comprehensive Health Association; provides board composition; authorizes incentive for participation in a disease management program; modifies plans; regulates health occupations and study required. |
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Mississippi |
Miss. Code Ann. § 43-13-117(2004) authorizes a disease management program for individuals with asthma, hypertension and diabetes. The program is optional and allows individuals to opt out at any time. The law also authorizes an obstetrical care population health management program for women and infants. |
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Missouri |
Mo. Rev. Stat. § 208.556 (2004) establishes the Missouri Senior Rx program and directs the program to implement cost-control measures, such as disease management programs. |
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Montana |
Mont. Code Ann. § 17-6-606 appropriates a portion of tobacco settlement proceeds to fund a statewide comprehensive tobacco disease prevention program. |
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Nebraska
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Ne. Act LB 1107 (2006) Provides for student self-management of diabetes at school and school-related activities; requires a written request from a parent or guardian
Ne. Rev. Stat. § 25-21, 280 (2006) Allows students with asthma or anaphylaxis to self-manage his or her condition |
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New Hampshire |
N.H. Laws, Chap. 420-G:4-a (2003) permits health insurers in the small group and individual markets to discount the premium rate for health benefit plans that include significant financial incentives for covered persons to participate in wellness or disease management programs. |
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New Jersey |
N.J. Laws, Chap. 122 (2003) directs the Commissioner of Health and Senior Services to establish a disease management program to improve quality and reduce costs in the Pharmaceutical Assistance to the Aged and Disabled and Senior Gold Prescription Discount program. |
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New Mexico |
N.M. Laws, Chap. 315 (2003) (Formerly SB 338)directs the Human Services Department to implement program change recommendations of the Medicaid Reform Committee, including the following: Provide or strengthen disease management programs for medical assistance recipients through "closer coordination with primary care and safety net providers." Expand participation in disease management programs by health care providers, particularly in underserved areas. Design a pilot disease management program for the fee-for-service population. |
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New York |
N.Y. Laws, Chap. 659 (2003) extends the chronic care management demonstration programs in certain counties through 2005. |
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North Carolina |
N.C. Gen. Stat. § 135-39.5 (2004) authorizes the Executive Administrator and Board of Trustees of the Teachers' and State Employees' Comprehensive Major Medical Plan to implement case management and disease management programs.
N.C. Session Law 2006-197 (Formerly HB 1860) estiblishes a stroke advisory council; provides for a ayatem to identify and disseminate information about the location of primary stroke centers. |
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Oklahoma
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Okla. Stat. Ann. tit. 74, § 1306.4 (2002) directs the board to implement a pilot disease management program with the purpose of reducing costs for the most costly diseases. The board is required to submit an annual report to the legislature about cost reduction measures. |
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Rhode Island
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R.I. Gen. Laws § 27-50-17 (2003) (Formerly HB 5909, Companion SB536)establishes a pilot program that allows health insurance carriers serving the small group market to offer an affordable health benefit plan that promotes wellness and disease management. The carrier may offer incentives or rebates for participation in the pilot program. |
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South Dakota |
S.D. Codified Laws Ann. § 58-17-131 (2003) requires health plans to include disease management programs that contain cost containment mechanisms. Enrollees who do not enroll in cost containment activities are responsible for fifty percent of eligible expenses for services after the deductible is met, and there is no maximum out-of-pocket coinsurance amount. |
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Tennessee
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TN Public Chapter No. 542 (2005) allows students with diabetes to preform care and management of the student's diabetes in any area of the school or school grounds adn at any school-related activity. |
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Texas |
Tex. Gov't. Code Ann. § 501.149 (2004) requires managed health care plans to provide disease management services to inmates.
Tex. Gov't. Code Ann. § 531.021912 (2004) requires the Health and Human Services Commission to develop a Medicaid disease management pilot program for children's asthma.
Tex. Gov't. Code Ann. § 531.070 (2004) allows the Health and Human Services Commission to enter into a written agreement with a manufacturer to accept certain program benefits - such as a disease management program or product donation program - in lieu of supplemental rebates.
Texas Gov't. Code § 533.009 (2004) requires the Health and Human Services Commission to ensure that Medicaid managed care organizations implement disease management programs to address chronic health conditions, such as asthma and diabetes, and use outcome measures to assess the programs. The commission is required to study the benefits and costs of disease management programs in Medicaid managed care.
Tex. Health and Safety Code Ann. § 13.003 (2004) permits the South Texas Health Care System to provide outpatient health care services, such as disease management and supportive care services.
Tex. Health and Safety Code Ann. § 62.159 (2004) requires the child health plan, managed health care plans and other health coverage plans to provide disease management services, including patient self-management education, provider education, evidence-based models and minimum standards of care. Chronic health conditions include heart disease, HIV infection, or AIDS, diabetes, respiratory illness and end-stage renal disease. Requires an evaluation of savings and clinical outcomes of participants enrolled in disease management programs. (HB 1735)
Tex. Health and Safety Code Ann. § 94.002 (2004) establishes a Hepatitis C education and prevention program that among other things, identifies to health care providers and employers the benefits of disease awareness and prevention.
Tex. Health and Safety Code Ann. § 95.001 et seq. (2004) authorizes a children's asthma disease management pilot study to compare preventative disease management methods for treating children's asthma compared to traditional methods of treating the disease. The study will focus on six areas of the state, both urban and rural, and will use techniques that are transferable to private practice and other geographic settings.
Tex. Health and Safety Code Ann. § 533.0354 (2004) requires local mental health authorities to provide disease management practices for adults with bipolar disorder, schizophrenia, or clinically severe depression and for children with serious mental illnesses.
Tex. Human Res. Code Ann. § 32.059 et seq. (2004) recommends expanding disease management programs to Medicaid recipients that are not eligible to receive disease management services under a Medicaid managed care plan. Chronic diseases include heart disease, hemophilia, diabetes, respiratory illness, end-stage renal disease, HIV infection, or AIDS. Requires the department to include a written guarantee of savings in disease management contracts. (HB 727) (Scroll down to correct section)
Section 2 authorized the Health and Human Services Commission to conduct a study to analyze the potential for state savings through the use of disease management programs for medical assistance recipients.
Tex. Ins. Code Ann. § 845.155 (2004) specifies that the statewide rural health care system may be used as a pilot or demonstration program to incorporate disease management and prevention principles.
Tex. Ins. Code Ann. § 845.201 (2004) states that the goals of the rural health care delivery system include emphasizing quality improvement and disease management.
Tex. Ins. Code Ann. § 1551.219 (2004) requires group health benefit plans for governmental employees to provide disease management services.
Tex. Ins. Code Ann. § 1575.162 (2004) requires health benefit plans for public school employees to provide disease management services. |
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Vermont
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VT Act 191 (Formerly HB 861) enhances the delivery of chronic care by codifying the blueprint for health chronic care prevention and management plan, unifying the chronic care efforts within the state, and initiating chronic care prevention and management in Medicaid and Catamount Health; establishes catamount health. |
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Washington
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Wash. Rev. Code Ann. § 41.05.013 (2004) directs state purchased health care policies to be based on scientific and medical evidence and explore strategies for disease management and demand management programs.
Wash. S.B. 5841 Substitute Chapter No. 462 (2005) establishes a disease management program for asthma state-wide. All school district employees must be trained on the symptoms, treatment, and monitoring of the disease. A comprehensive plan shall be implemented that coordinates the cost effectiveness, treatment, definition, and terms of care across state agencies. |
Source: National Conference of State Legislatures.
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