Disease Management - - CA Health And Safety

Section § 1399.900

This law defines what a "disease management organization" is. It refers to entities providing programs and services for managing diseases, primarily by working with health care plans, employers, public health programs, or government agencies. However, entities mainly selling specific products to health care plan members are not considered disease management organizations. Also, medical groups, licensed professionals, or health facilities that offer disease management as a secondary part of their practice are excluded from this definition.

(a) For the purposes of this chapter, “disease management organization” means an entity that provides disease management programs and services and that contracts with any of the following:

(1) A health care service plan.

(2) A contractor of a health care service plan.

(3) An employer.

(4) A publicly financed health care program.

(5) A government agency.

(b) A disease management organization shall not include an entity whose primary purpose is to market specific products or services to enrollees of a health care service plan.

(c) No medical group, individual licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or health facility as defined in Section 1250, that provides disease management programs and services incidental to their primary professional practices, shall be considered a disease management organization.

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(Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)

Section § 1399.901

This law defines "disease management programs and services" as efforts aimed at improving patients' health and preventing further health issues. These services should use cost-effective, evidence-based guidelines and promote patient self-management. Key components of these programs must include identifying the patient population, using clinical guidelines to assess and respond to risks, educating patients about managing their diseases, and measuring and evaluating outcomes.

For the purposes of this chapter, “disease management programs and services” means services administered to patients in order to improve their overall health and to prevent clinical exacerbations and complications utilizing cost-effective, evidence-based, or consensus-based practice guidelines and patient self-management strategies. Disease management programs and services shall contain all of the following:

(a) A population identification process.

(b) Evidence-based or consensus-based clinical practice guidelines, risk identification, and matching of interventions with clinical need.

(c) Patient self-management and disease education.

(d) Process and outcomes measurement, evaluation, management, and reporting.

disease management patient health improvement preventing health complications clinical practice guidelines patient self-management population identification risk identification intervention matching disease education outcomes measurement cost-effective care evidence-based practices consensus-based guidelines process evaluation health services reporting

(Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)

Section § 1399.902

Disease management organizations in California must get approval from a doctor before providing certain services. Specifically, they need authorization to offer home health care or to give, prescribe, or manage prescription medications for patients.

A valid prescription from a treating doctor counts as this approval for medications. However, if a home health care visit is only for checking on, assessing, or educating a patient, it doesn't need prior authorization.

This law simply clarifies there's no new authority added for these actions without proper authorization from other laws.

(a) Every disease management organization shall obtain physician authorization prior to the time that the disease management organization, its employees, or independent contractors do either of the following:

(1) Provide home health care services utilized in the treatment of a patient.

(2) Dispense, administer, or prescribe a prescription medication.

(b) For purposes of this section, a valid prescription written by a treating physician shall constitute authorization to dispense a prescription medication.

(c) Home health care followup visits made solely for patient assessment, monitoring, or education are not subject to the physician authorization requirement in subdivision (a).

(d) Nothing in this section, in the absence of authorization granted by any other law, shall be construed to authorize the activities described in paragraphs (1) and (2) of subdivision (a).

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(Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)

Section § 1399.903

This California law allows disease management organizations to receive medical information under certain conditions outlined in a specific part of the Civil Code. However, these organizations must still follow all other confidentiality rules under the Confidentiality of Medical Information Act. This includes complying with specific parts of the Civil Code that emphasize the protection and privacy of medical information.

A disease management organization may receive medical information as provided in paragraph (17) of subdivision (c) of Section 56.10 of the Civil Code. However, a disease management organization shall be subject to the other provisions of the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), including, but not limited to, subdivisions (d) and (e) of Section 56.10 of, and Section 56.36 of, the Civil Code.

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(Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)

Section § 1399.904

This law states that a disease management organization can't use medical information from a health care plan member to try to sell them products or services related to their disease management. However, if a member chooses to get information on health care products and services through the organization, it can offer products or services directly linked to the member's condition.

A disease management organization shall not use medical information obtained pursuant to Section 1399.903 to solicit or to offer for sale to a health care service plan enrollee any products or services in the provision of disease management services to the enrollee. However, an enrollee may elect to use a disease management organization to obtain information about health care products and services and, pursuant to that election by the enrollee, the disease management organization may offer to the enrollee health care products or services that are directly related to the enrollee’s condition.

disease management medical information health care service plan enrollee solicitation product offerings health care products services related to condition election by enrollee information use restrictions member choices directly related services health conditions information privacy service restrictions

(Added by Stats. 2000, Ch. 1065, Sec. 2. Effective January 1, 2001.)