Thompson Bill Makes Medicaid Pay For Obesity Drugs And Surgery

The text as introduced · 718 words

89R5303 AB-D

By: Thompson
H.B. No. 2677

A BILL TO BE ENTITLED

AN ACT

relating to Medicaid coverage and reimbursement for the treatment

of obesity and certain diabetes prevention program services.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Sections 32.02461 and 32.02462 to read as

follows:

Sec. 32.02461. REIMBURSEMENT FOR TREATING OBESITY. (a) In

this section:

(1) "Anti-obesity medication" means a prescription

medication approved by the United States Food and Drug

Administration that is indicated for chronic weight management in

an individual who is diagnosed with obesity.

(2) "Intensive health behavioral and lifestyle

treatment" means an evidence-based, multi-component behavioral or

lifestyle modification intervention that supports healthy weight

management.

(3) "Metabolic and bariatric surgery" means a surgical

procedure that:

(A) alters the stomach, the intestines, or both

to cause weight loss in an individual diagnosed with obesity or an

obesity-related metabolic disorder; and

(B) is endorsed by the American Society for

Metabolic and Bariatric Surgery.

(4) "Recipient" means a recipient of medical

assistance.

(5) "Telehealth service" and "telemedicine medical

service" have the meanings assigned by Section 111.001, Occupations

Code.

(b) The commission shall ensure that medical assistance

reimbursement is provided for health care services provided to a

recipient for the treatment of the chronic disease of obesity,

including:

(1) intensive health behavioral and lifestyle

treatment services;

(2) metabolic and bariatric surgery; and

(3) anti-obesity medication.

(c) Intensive health behavior and lifestyle treatment

services provided under the medical assistance program may include

interventions certified or recognized by the Centers for Disease

Control and Prevention or recommended by current clinical standards

of care. The services may be provided in person, including in

office or in a community-based setting, or remotely as a telehealth

service or telemedicine medical service.

(d) The executive commissioner by rule shall establish

medical necessity criteria for anti-obesity medications provided

under the medical assistance program. The criteria may not be more

restrictive than the indications for the medications that are

approved by the United States Food and Drug Administration.

(e) The commission or a Medicaid managed care organization

may apply utilization management to determine medical necessity for

a health care service authorized under this section only if the

determinations of appropriateness and medical necessity are made in

the same manner as those determinations are made for other health

care services provided under the medical assistance program.

(f) The executive commissioner shall adopt rules necessary

to implement this section.

Sec. 32.02462. REIMBURSEMENT FOR DIABETES PREVENTION

PROGRAM SERVICES. (a) In this section:

(1) "Diabetes prevention program" means a program

designed to prevent or delay the onset of Type 2 diabetes by

providing a person enrolled in the program a series of structured

behavioral health change sessions based on a curriculum approved by

the Centers for Disease Control and Prevention.

(2) "Diabetes prevention program supplier" means an

entity included in the National Registry of Recognized Diabetes

Prevention Programs maintained by the Centers for Disease Control

and Prevention.

(3) "Recipient" means a recipient of medical

assistance.

(b) The commission shall ensure that medical assistance

reimbursement is provided to a diabetes prevention program supplier

for services provided to a recipient enrolled in a diabetes

prevention program if the recipient:

(1) meets the program's eligibility requirements; and

(2) has not previously participated in the program

while a recipient.

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. As soon as practicable after the date Section

32.02461, Human Resources Code, as added by this Act, is

implemented, the Health and Human Services Commission shall provide

written notice to recipients of medical assistance under Chapter

32, Human Resources Code, regarding the availability of obesity

treatment options under the medical assistance program.

SECTION 4. This Act takes effect immediately if it receives

a vote of two-thirds of all the members elected to each house, as

provided by Section 39, Article III, Texas Constitution. If this

Act does not receive the vote necessary for immediate effect, this

Act takes effect September 1, 2025.