89R10059 CMO-F
By: Plesa H.B. No. 5488
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid reimbursement for coordinated specialty care
for first episode psychosis.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.02463 to read as follows:
Sec. 32.02463. REIMBURSEMENT FOR COORDINATED SPECIALTY
CARE FOR FIRST EPISODE PSYCHOSIS. (a) In this section:
(1) "Coordinated specialty care for first episode
psychosis" means coordinated specialty care and services provided
to an individual who is diagnosed with first episode psychosis,
which may include:
(A) any element of the treatment model included
in the Recovery After an Initial Schizophrenia Episode (RAISE)
early treatment program study conducted by the National Institute
of Mental Health regarding treatment for psychosis, as completed
July 2017, including:
(i) psychotherapy;
(ii) medication management;
(iii) case management;
(iv) family education and support; and
(v) education and employment support;
(B) assertive community treatment as described
by the commission's Texas Resilience and Recovery Utilization
Management Guidelines: Adult Mental Health Services, as updated in
April 2017, or a more recently updated version adopted by the
executive commissioner; and
(C) peer support services, including:
(i) recovery and wellness support;
(ii) mentoring; and
(iii) advocacy.
(2) "First episode psychosis" means the initial onset
of psychosis or symptoms associated with psychosis, caused by:
(A) medical or neurological conditions;
(B) serious mental illness; or
(C) substance use.
(3) "Recipient" means a recipient of medical
assistance.
(b) The commission shall ensure that medical assistance
reimbursement is provided to a provider who provides one or more
services classified as coordinated specialty care for first episode
psychosis to a recipient experiencing first episode psychosis.
(c) A provider is eligible to receive medical assistance
reimbursement for the provision of specialty care for first episode
psychosis to a recipient only if the provider:
(1) has contracted with the commission or a managed
care organization to provide that care; and
(2) provides the care in a manner that adheres to the
fidelity of the applicable treatment model the provider follows.
(d) If a psychiatrist or licensed clinical leader of a
treatment team is credentialed to provide coordinated specialty
care for first episode psychosis under the medical assistance
program, each member of the treatment team serving under the
credentialed psychiatrist or licensed clinical leader is
considered to be credentialed to provide that care.
(e) This section may not be construed to require that a
provider of coordinated specialty care treatment for first episode
psychosis provide every coordinated care service to a recipient in
order to receive medical assistance reimbursement.
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. This Act takes effect September 1, 2025.