Medicaid pays for dementia assessment and care planning

The text as introduced · 365 words

89R15290 LRM-F

By: Thompson
H.B. No. 4760

A BILL TO BE ENTITLED

AN ACT

relating to Medicaid reimbursement for the costs of cognitive

assessment and care planning services provided to certain patients.

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

SECTION 1. Subchapter D, Chapter 532, Government Code, as

effective April 1, 2025, is amended by adding Section 532.0158 to

read as follows:

Sec. 532.0158. REIMBURSEMENT SYSTEM FOR COGNITIVE CARE

PLANNING. (a) The executive commissioner by rule shall develop and

the commission shall implement a system to provide Medicaid

reimbursement to a health care provider, including a physician, for

the assessment of and care planning services provided to patients

with a cognitive impairment, including dementia or Alzheimer's

disease.

(b) To be eligible for reimbursement under this section, the

health care provider's care planning services must include:

(1) assessment of the patient's cognition, function,

and safety;

(2) an evaluation of the patient's neuropsychiatric

and behavioral symptoms;

(3) a review of the patient's medications;

(4) a needs assessment for the patient's caregiver;

(5) a comprehensive clinical visit for the patient;

and

(6) a complete written care plan for the patient.

(c) The executive commissioner shall prepare and seek a

waiver to the state Medicaid plan under Section 1115 of the Social

Security Act (42 U.S.C. Section 1315) or other applicable federal

law to obtain any federal money available for implementing the

system to assist eligible individuals in obtaining care planning

services.

SECTION 2. (a) As soon as practicable after the effective

date of this Act, the executive commissioner of the Health and Human

Services Commission shall adopt the rules necessary to implement

Section 532.0158, Government Code, as added by this Act.

(b) As soon as practicable after the effective date of this

Act, the executive commissioner of the Health and Human Services

Commission shall apply for and actively pursue from the federal

Centers for Medicare and Medicaid Services or another appropriate

federal agency the waiver required by Section 532.0158, Government

Code, as added by this Act. The commission may delay implementing

Section 532.0158, Government Code, until the waiver applied for

under this section is granted.

SECTION 3. This Act takes effect September 1, 2025.