Medicaid managed care can substitute non-medical services

The text as introduced · 367 words

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.