By: Johnson S.B. No. 236
A BILL TO BE ENTITLED
AN ACT
relating to certain evidence-based health-related non-medical
services offered by a Medicaid managed care organization in lieu of
other services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.005(h), Government Code, is amended
to read as follows:
(h) In addition to the requirements specified by Subsection
(a), a contract described by that subsection must contain language
permitting a managed care organization to offer medically
appropriate, cost-effective, evidence-based mental health or
substance use disorder services and health-related non-medical
services from a list [approved by the state Medicaid managed care
advisory committee and] included in the contract in lieu of [mental
health or substance use disorder] services specified in the state
Medicaid plan. A recipient is not required to use a service from
the list included in the contract in lieu of another [mental health
or substance use disorder] service specified in the state Medicaid
plan. The commission shall:
(1) prepare and submit an annual report to the
legislature on the number of times during the preceding year a
service from the list included in the contract is used; and
(2) take into consideration the actual cost and use of
any services from the list included in the contract that are offered
by a managed care organization when setting the capitation rates
for that organization under the contract.
SECTION 2. Section 533.005(h), Government Code, as amended
by this Act, applies to a contract entered into or renewed on or
after the effective date of this Act. A contract entered into or
renewed before that date is governed by the law in effect on the
date the contract was entered into or renewed, and that law is
continued in effect for that purpose.
SECTION 3. 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 4. This Act takes effect September 1, 2025.