Medicaid pays for first episode psychosis care

The text as introduced · 497 words

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.