89R5303 AB-D
By: Thompson H.B. No. 2677
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid coverage and reimbursement for the treatment
of obesity and certain diabetes prevention program services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Sections 32.02461 and 32.02462 to read as
follows:
Sec. 32.02461. REIMBURSEMENT FOR TREATING OBESITY. (a) In
this section:
(1) "Anti-obesity medication" means a prescription
medication approved by the United States Food and Drug
Administration that is indicated for chronic weight management in
an individual who is diagnosed with obesity.
(2) "Intensive health behavioral and lifestyle
treatment" means an evidence-based, multi-component behavioral or
lifestyle modification intervention that supports healthy weight
management.
(3) "Metabolic and bariatric surgery" means a surgical
procedure that:
(A) alters the stomach, the intestines, or both
to cause weight loss in an individual diagnosed with obesity or an
obesity-related metabolic disorder; and
(B) is endorsed by the American Society for
Metabolic and Bariatric Surgery.
(4) "Recipient" means a recipient of medical
assistance.
(5) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001, Occupations
Code.
(b) The commission shall ensure that medical assistance
reimbursement is provided for health care services provided to a
recipient for the treatment of the chronic disease of obesity,
including:
(1) intensive health behavioral and lifestyle
treatment services;
(2) metabolic and bariatric surgery; and
(3) anti-obesity medication.
(c) Intensive health behavior and lifestyle treatment
services provided under the medical assistance program may include
interventions certified or recognized by the Centers for Disease
Control and Prevention or recommended by current clinical standards
of care. The services may be provided in person, including in
office or in a community-based setting, or remotely as a telehealth
service or telemedicine medical service.
(d) The executive commissioner by rule shall establish
medical necessity criteria for anti-obesity medications provided
under the medical assistance program. The criteria may not be more
restrictive than the indications for the medications that are
approved by the United States Food and Drug Administration.
(e) The commission or a Medicaid managed care organization
may apply utilization management to determine medical necessity for
a health care service authorized under this section only if the
determinations of appropriateness and medical necessity are made in
the same manner as those determinations are made for other health
care services provided under the medical assistance program.
(f) The executive commissioner shall adopt rules necessary
to implement this section.
Sec. 32.02462. REIMBURSEMENT FOR DIABETES PREVENTION
PROGRAM SERVICES. (a) In this section:
(1) "Diabetes prevention program" means a program
designed to prevent or delay the onset of Type 2 diabetes by
providing a person enrolled in the program a series of structured
behavioral health change sessions based on a curriculum approved by
the Centers for Disease Control and Prevention.
(2) "Diabetes prevention program supplier" means an
entity included in the National Registry of Recognized Diabetes
Prevention Programs maintained by the Centers for Disease Control
and Prevention.
(3) "Recipient" means a recipient of medical
assistance.
(b) The commission shall ensure that medical assistance
reimbursement is provided to a diabetes prevention program supplier
for services provided to a recipient enrolled in a diabetes
prevention program if the recipient:
(1) meets the program's eligibility requirements; and
(2) has not previously participated in the program
while a recipient.
SECTION 2. 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 3. As soon as practicable after the date Section
32.02461, Human Resources Code, as added by this Act, is
implemented, the Health and Human Services Commission shall provide
written notice to recipients of medical assistance under Chapter
32, Human Resources Code, regarding the availability of obesity
treatment options under the medical assistance program.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.