| 1 | 1 | | 89R15290 LRM-F |
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| 2 | 2 | | By: Thompson H.B. No. 4760 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to Medicaid reimbursement for the costs of cognitive |
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| 10 | 10 | | assessment and care planning services provided to certain patients. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Subchapter D, Chapter 532, Government Code, as |
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| 13 | 13 | | effective April 1, 2025, is amended by adding Section 532.0158 to |
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| 14 | 14 | | read as follows: |
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| 15 | 15 | | Sec. 532.0158. REIMBURSEMENT SYSTEM FOR COGNITIVE CARE |
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| 16 | 16 | | PLANNING. (a) The executive commissioner by rule shall develop and |
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| 17 | 17 | | the commission shall implement a system to provide Medicaid |
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| 18 | 18 | | reimbursement to a health care provider, including a physician, for |
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| 19 | 19 | | the assessment of and care planning services provided to patients |
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| 20 | 20 | | with a cognitive impairment, including dementia or Alzheimer's |
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| 21 | 21 | | disease. |
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| 22 | 22 | | (b) To be eligible for reimbursement under this section, the |
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| 23 | 23 | | health care provider's care planning services must include: |
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| 24 | 24 | | (1) assessment of the patient's cognition, function, |
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| 25 | 25 | | and safety; |
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| 26 | 26 | | (2) an evaluation of the patient's neuropsychiatric |
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| 27 | 27 | | and behavioral symptoms; |
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| 28 | 28 | | (3) a review of the patient's medications; |
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| 29 | 29 | | (4) a needs assessment for the patient's caregiver; |
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| 30 | 30 | | (5) a comprehensive clinical visit for the patient; |
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| 31 | 31 | | and |
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| 32 | 32 | | (6) a complete written care plan for the patient. |
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| 33 | 33 | | (c) The executive commissioner shall prepare and seek a |
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| 34 | 34 | | waiver to the state Medicaid plan under Section 1115 of the Social |
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| 35 | 35 | | Security Act (42 U.S.C. Section 1315) or other applicable federal |
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| 36 | 36 | | law to obtain any federal money available for implementing the |
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| 37 | 37 | | system to assist eligible individuals in obtaining care planning |
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| 38 | 38 | | services. |
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| 39 | 39 | | SECTION 2. (a) As soon as practicable after the effective |
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| 40 | 40 | | date of this Act, the executive commissioner of the Health and Human |
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| 41 | 41 | | Services Commission shall adopt the rules necessary to implement |
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| 42 | 42 | | Section 532.0158, Government Code, as added by this Act. |
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| 43 | 43 | | (b) As soon as practicable after the effective date of this |
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| 44 | 44 | | Act, the executive commissioner of the Health and Human Services |
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| 45 | 45 | | Commission shall apply for and actively pursue from the federal |
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| 46 | 46 | | Centers for Medicare and Medicaid Services or another appropriate |
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| 47 | 47 | | federal agency the waiver required by Section 532.0158, Government |
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| 48 | 48 | | Code, as added by this Act. The commission may delay implementing |
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| 49 | 49 | | Section 532.0158, Government Code, until the waiver applied for |
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| 50 | 50 | | under this section is granted. |
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| 51 | 51 | | SECTION 3. This Act takes effect September 1, 2025. |
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