By: Hinojosa, et al. S.B. No. 796
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. SUBSTANCE ABUSE TREATMENT EVALUATION.
(a) The commission shall monitor the provision of 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 and analyze data relating to the provision of those
services. The commission shall provide the data to the Legislative
Budget Board in the format and at the times requested by the
Legislative Budget Board.
(b) The data analyzed and provided under Subsection (a)
must:
(1) 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; and
(2) include at least the following:
(A) the number of recipients to whom
comprehensive substance abuse treatment is provided;
(B) the type of substance abuse treatment
provided;
(C) the average annual cost per recipient of
treatment under the Medicaid program, other than the comprehensive
substance abuse treatment, including inpatient services other than
inpatient labor and delivery services, emergency department
services, outpatient services, and pharmaceutical and ancillary
services;
(D) the average annual cost per recipient of the
comprehensive substance abuse treatment; and
(E) the average annual number per recipient of:
(i) inpatient days;
(ii) emergency department visits; and
(iii) outpatient visits.
(c) The commission shall collect the data listed in
Subsections (b)(2)(C) and (E) for Medicaid recipients who are at
least 21 years of age and with respect to whom there is no evidence
of a substance abuse disorder for the same period described by
Subsection (b).
(d) The commission shall ensure that data is analyzed 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 provided by the commission, the
Legislative Budget Board 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. Not later than February 1, 2013, the
Legislative Budget Board shall prepare and publish a report of the
data. The Legislative Budget Board shall provide a draft of the
report to the commission before publishing the report.
(f) If the Legislative Budget Board 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 may not continue to provide those
services to a Medicaid recipient who is at least 21 years of age.
(g) This section expires March 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 data evaluated under Section
531.0226, Government Code, the Legislative Budget Board determines
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. 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 4. This Act takes effect September 1, 2009.