| 1 | 1 | | By: Johnson S.B. No. 236 |
|---|
| 2 | 2 | | |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | |
|---|
| 6 | 6 | | A BILL TO BE ENTITLED |
|---|
| 7 | 7 | | AN ACT |
|---|
| 8 | 8 | | relating to certain evidence-based health-related non-medical |
|---|
| 9 | 9 | | services offered by a Medicaid managed care organization in lieu of |
|---|
| 10 | 10 | | other services. |
|---|
| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 12 | 12 | | SECTION 1. Section 533.005(h), Government Code, is amended |
|---|
| 13 | 13 | | to read as follows: |
|---|
| 14 | 14 | | (h) In addition to the requirements specified by Subsection |
|---|
| 15 | 15 | | (a), a contract described by that subsection must contain language |
|---|
| 16 | 16 | | permitting a managed care organization to offer medically |
|---|
| 17 | 17 | | appropriate, cost-effective, evidence-based mental health or |
|---|
| 18 | 18 | | substance use disorder services and health-related non-medical |
|---|
| 19 | 19 | | services from a list [approved by the state Medicaid managed care |
|---|
| 20 | 20 | | advisory committee and] included in the contract in lieu of [mental |
|---|
| 21 | 21 | | health or substance use disorder] services specified in the state |
|---|
| 22 | 22 | | Medicaid plan. A recipient is not required to use a service from |
|---|
| 23 | 23 | | the list included in the contract in lieu of another [mental health |
|---|
| 24 | 24 | | or substance use disorder] service specified in the state Medicaid |
|---|
| 25 | 25 | | plan. The commission shall: |
|---|
| 26 | 26 | | (1) prepare and submit an annual report to the |
|---|
| 27 | 27 | | legislature on the number of times during the preceding year a |
|---|
| 28 | 28 | | service from the list included in the contract is used; and |
|---|
| 29 | 29 | | (2) take into consideration the actual cost and use of |
|---|
| 30 | 30 | | any services from the list included in the contract that are offered |
|---|
| 31 | 31 | | by a managed care organization when setting the capitation rates |
|---|
| 32 | 32 | | for that organization under the contract. |
|---|
| 33 | 33 | | SECTION 2. Section 533.005(h), Government Code, as amended |
|---|
| 34 | 34 | | by this Act, applies to a contract entered into or renewed on or |
|---|
| 35 | 35 | | after the effective date of this Act. A contract entered into or |
|---|
| 36 | 36 | | renewed before that date is governed by the law in effect on the |
|---|
| 37 | 37 | | date the contract was entered into or renewed, and that law is |
|---|
| 38 | 38 | | continued in effect for that purpose. |
|---|
| 39 | 39 | | SECTION 3. If before implementing any provision of this Act |
|---|
| 40 | 40 | | a state agency determines that a waiver or authorization from a |
|---|
| 41 | 41 | | federal agency is necessary for implementation of that provision, |
|---|
| 42 | 42 | | the agency affected by the provision shall request the waiver or |
|---|
| 43 | 43 | | authorization and may delay implementing that provision until the |
|---|
| 44 | 44 | | waiver or authorization is granted. |
|---|
| 45 | 45 | | SECTION 4. This Act takes effect September 1, 2025. |
|---|