81R3558 UM-D
By: Martinez H.B. No. 1708
A BILL TO BE ENTITLED
AN ACT
relating to the provision and evaluation of comprehensive substance
abuse treatment under the state Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0226 to read as follows:
Sec. 531.0226. STUDY REGARDING COMPREHENSIVE SUBSTANCE
ABUSE TREATMENT. (a) The commission shall conduct a study
regarding the cost-effectiveness of providing comprehensive
substance abuse treatment, as described by Section 32.024(ff),
Human Resources Code, to Medicaid recipients who are at least 21
years of age.
(b) To evaluate the cost-effectiveness of providing
comprehensive substance abuse treatment to Medicaid recipients,
the commission shall identify and use specific outcome measures.
The outcome measures must be measured in three consecutive years,
including the year before the year in which the recipient receives
comprehensive substance abuse treatment, the year in which the
treatment is first provided to the recipient, and the year
following the year in which the treatment is first provided to the
recipient. The study must include, for Medicaid recipients who
receive comprehensive substance abuse treatment, at least the
following outcome measures:
(1) the average annual cost per recipient of a
recipient's treatment under the Medicaid program, other than the
comprehensive substance abuse treatment, including inpatient
services other than inpatient labor and delivery services,
outpatient services, and pharmaceutical and ancillary services;
(2) the average annual cost per recipient of the
comprehensive substance abuse treatment; and
(3) the average annual number, per recipient, of:
(A) inpatient days;
(B) emergency department visits; and
(C) outpatient visits.
(c) To evaluate cost and utilization trends among Medicaid
recipients who are at least 21 years of age and with respect to whom
there is no evidence of a substance abuse disorder, the commission
shall collect data regarding the outcome measures listed in
Subsections (b)(1) and (3) for the same period described by
Subsection (b).
(d) In conducting the study, the commission shall ensure
that outcome data is evaluated using:
(1) appropriate demographic categories, including
recipient age, disability, and income; and
(2) the type of service delivery model through which
the recipient received services through Medicaid, including the
fee-for-service, primary care case management, and health
maintenance organization models.
(e) Using the data collected during the study, the
commission shall evaluate cost and utilization trends and whether
the provision of comprehensive substance abuse treatment through
the state Medicaid program results in an increase in overall
Medicaid spending. The commission shall prepare a report of the
study data and the commission's determination and, not later than
December 1, 2012, submit the report to the governor, the state
auditor, and the Legislative Budget Board.
(f) If the commission determines that the provision of
comprehensive substance abuse treatment through the state Medicaid
program has resulted in an increase in overall Medicaid spending,
the commission:
(1) may not continue to provide those services to a
Medicaid recipient who is at least 21 years of age; and
(2) shall, in the report required by Subsection (e),
recommend the repeal of Section 32.024(ff), Human Resources Code.
(g) This section expires January 1, 2013.
SECTION 2. Section 32.024, Human Resources Code, is amended
by adding Subsection (ff) to read as follows:
(ff) Except as otherwise provided by this subsection, the
department shall provide comprehensive substance abuse treatment
under the medical assistance program to a person who is at least 21
years of age, has a substance abuse disorder, and otherwise
qualifies for medical assistance. The department may not provide
the treatment if, based on the study conducted under Section
531.0226, Government Code, a determination is made that the
treatment resulted in an increase in overall medical assistance
program spending. Comprehensive substance abuse treatment
includes assessment, residential detoxification, outpatient
detoxification, methadone maintenance, residential services,
specialized residential services for women, outpatient chemical
dependency counseling, and any other necessary services as
determined by the department.
SECTION 3. Not later than December 1, 2009, the Health and
Human Services Commission shall submit to the Legislative Budget
Board for approval the commission's proposed methodology,
including outcome measures selected, for the cost-effectiveness
study required by Section 531.0226, Government Code, as added by
this Act.
SECTION 4. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. This Act takes effect September 1, 2009.