Texas 2025 - 89th Regular

Texas House Bill HB2677 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R5303 AB-D
2	2	By: Thompson H.B. No. 2677
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to Medicaid coverage and reimbursement for the treatment
10	10	of obesity and certain diabetes prevention program services.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
13	13	is amended by adding Sections 32.02461 and 32.02462 to read as
14	14	follows:
15	15	Sec. 32.02461. REIMBURSEMENT FOR TREATING OBESITY. (a) In
16	16	this section:
17	17	(1) "Anti-obesity medication" means a prescription
18	18	medication approved by the United States Food and Drug
19	19	Administration that is indicated for chronic weight management in
20	20	an individual who is diagnosed with obesity.
21	21	(2) "Intensive health behavioral and lifestyle
22	22	treatment" means an evidence-based, multi-component behavioral or
23	23	lifestyle modification intervention that supports healthy weight
24	24	management.
25	25	(3) "Metabolic and bariatric surgery" means a surgical
26	26	procedure that:
27	27	(A) alters the stomach, the intestines, or both
28	28	to cause weight loss in an individual diagnosed with obesity or an
29	29	obesity-related metabolic disorder; and
30	30	(B) is endorsed by the American Society for
31	31	Metabolic and Bariatric Surgery.
32	32	(4) "Recipient" means a recipient of medical
33	33	assistance.
34	34	(5) "Telehealth service" and "telemedicine medical
35	35	service" have the meanings assigned by Section 111.001, Occupations
36	36	Code.
37	37	(b) The commission shall ensure that medical assistance
38	38	reimbursement is provided for health care services provided to a
39	39	recipient for the treatment of the chronic disease of obesity,
40	40	including:
41	41	(1) intensive health behavioral and lifestyle
42	42	treatment services;
43	43	(2) metabolic and bariatric surgery; and
44	44	(3) anti-obesity medication.
45	45	(c) Intensive health behavior and lifestyle treatment
46	46	services provided under the medical assistance program may include
47	47	interventions certified or recognized by the Centers for Disease
48	48	Control and Prevention or recommended by current clinical standards
49	49	of care. The services may be provided in person, including in
50	50	office or in a community-based setting, or remotely as a telehealth
51	51	service or telemedicine medical service.
52	52	(d) The executive commissioner by rule shall establish
53	53	medical necessity criteria for anti-obesity medications provided
54	54	under the medical assistance program. The criteria may not be more
55	55	restrictive than the indications for the medications that are
56	56	approved by the United States Food and Drug Administration.
57	57	(e) The commission or a Medicaid managed care organization
58	58	may apply utilization management to determine medical necessity for
59	59	a health care service authorized under this section only if the
60	60	determinations of appropriateness and medical necessity are made in
61	61	the same manner as those determinations are made for other health
62	62	care services provided under the medical assistance program.
63	63	(f) The executive commissioner shall adopt rules necessary
64	64	to implement this section.
65	65	Sec. 32.02462. REIMBURSEMENT FOR DIABETES PREVENTION
66	66	PROGRAM SERVICES. (a) In this section:
67	67	(1) "Diabetes prevention program" means a program
68	68	designed to prevent or delay the onset of Type 2 diabetes by
69	69	providing a person enrolled in the program a series of structured
70	70	behavioral health change sessions based on a curriculum approved by
71	71	the Centers for Disease Control and Prevention.
72	72	(2) "Diabetes prevention program supplier" means an
73	73	entity included in the National Registry of Recognized Diabetes
74	74	Prevention Programs maintained by the Centers for Disease Control
75	75	and Prevention.
76	76	(3) "Recipient" means a recipient of medical
77	77	assistance.
78	78	(b) The commission shall ensure that medical assistance
79	79	reimbursement is provided to a diabetes prevention program supplier
80	80	for services provided to a recipient enrolled in a diabetes
81	81	prevention program if the recipient:
82	82	(1) meets the program's eligibility requirements; and
83	83	(2) has not previously participated in the program
84	84	while a recipient.
85	85	SECTION 2. If before implementing any provision of this Act
86	86	a state agency determines that a waiver or authorization from a
87	87	federal agency is necessary for implementation of that provision,
88	88	the agency affected by the provision shall request the waiver or
89	89	authorization and may delay implementing that provision until the
90	90	waiver or authorization is granted.
91	91	SECTION 3. As soon as practicable after the date Section
92	92	32.02461, Human Resources Code, as added by this Act, is
93	93	implemented, the Health and Human Services Commission shall provide
94	94	written notice to recipients of medical assistance under Chapter
95	95	32, Human Resources Code, regarding the availability of obesity
96	96	treatment options under the medical assistance program.
97	97	SECTION 4. This Act takes effect immediately if it receives
98	98	a vote of two-thirds of all the members elected to each house, as
99	99	provided by Section 39, Article III, Texas Constitution. If this
100	100	Act does not receive the vote necessary for immediate effect, this
101	101	Act takes effect September 1, 2025.