Chapter 2.25. Disease Management of California Health And Safety Code >> Division 2. >> Chapter 2.25.
(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
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
(c) Patient self-management and disease education.
(d) Process and outcomes measurement, evaluation, management, and
(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
(1) Provide home health care services utilized in the treatment of
(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
(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).
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.
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