Texas 2025 - 89th Regular

Texas House Bill HB5488 Compare Versions

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

Old	New	Differences
1	1	89R10059 CMO-F
2	2	By: Plesa H.B. No. 5488
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to Medicaid reimbursement for coordinated specialty care
10	10	for first episode psychosis.
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 Section 32.02463 to read as follows:
14	14	Sec. 32.02463. REIMBURSEMENT FOR COORDINATED SPECIALTY
15	15	CARE FOR FIRST EPISODE PSYCHOSIS. (a) In this section:
16	16	(1) "Coordinated specialty care for first episode
17	17	psychosis" means coordinated specialty care and services provided
18	18	to an individual who is diagnosed with first episode psychosis,
19	19	which may include:
20	20	(A) any element of the treatment model included
21	21	in the Recovery After an Initial Schizophrenia Episode (RAISE)
22	22	early treatment program study conducted by the National Institute
23	23	of Mental Health regarding treatment for psychosis, as completed
24	24	July 2017, including:
25	25	(i) psychotherapy;
26	26	(ii) medication management;
27	27	(iii) case management;
28	28	(iv) family education and support; and
29	29	(v) education and employment support;
30	30	(B) assertive community treatment as described
31	31	by the commission's Texas Resilience and Recovery Utilization
32	32	Management Guidelines: Adult Mental Health Services, as updated in
33	33	April 2017, or a more recently updated version adopted by the
34	34	executive commissioner; and
35	35	(C) peer support services, including:
36	36	(i) recovery and wellness support;
37	37	(ii) mentoring; and
38	38	(iii) advocacy.
39	39	(2) "First episode psychosis" means the initial onset
40	40	of psychosis or symptoms associated with psychosis, caused by:
41	41	(A) medical or neurological conditions;
42	42	(B) serious mental illness; or
43	43	(C) substance use.
44	44	(3) "Recipient" means a recipient of medical
45	45	assistance.
46	46	(b) The commission shall ensure that medical assistance
47	47	reimbursement is provided to a provider who provides one or more
48	48	services classified as coordinated specialty care for first episode
49	49	psychosis to a recipient experiencing first episode psychosis.
50	50	(c) A provider is eligible to receive medical assistance
51	51	reimbursement for the provision of specialty care for first episode
52	52	psychosis to a recipient only if the provider:
53	53	(1) has contracted with the commission or a managed
54	54	care organization to provide that care; and
55	55	(2) provides the care in a manner that adheres to the
56	56	fidelity of the applicable treatment model the provider follows.
57	57	(d) If a psychiatrist or licensed clinical leader of a
58	58	treatment team is credentialed to provide coordinated specialty
59	59	care for first episode psychosis under the medical assistance
60	60	program, each member of the treatment team serving under the
61	61	credentialed psychiatrist or licensed clinical leader is
62	62	considered to be credentialed to provide that care.
63	63	(e) This section may not be construed to require that a
64	64	provider of coordinated specialty care treatment for first episode
65	65	psychosis provide every coordinated care service to a recipient in
66	66	order to receive medical assistance reimbursement.
67	67	SECTION 2. If before implementing any provision of this Act
68	68	a state agency determines that a waiver or authorization from a
69	69	federal agency is necessary for implementation of that provision,
70	70	the agency affected by the provision shall request the waiver or
71	71	authorization and may delay implementing that provision until the
72	72	waiver or authorization is granted.
73	73	SECTION 3. This Act takes effect September 1, 2025.