LEGISLATIVE BUDGET BOARD
Austin, Texas
 
FISCAL NOTE, 88TH LEGISLATIVE REGULAR SESSION
 
May 16, 2023

TO:
Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services
 
FROM:
Jerry McGinty, Director, Legislative Budget Board
 
IN RE:
HB4169 by Price (Relating to providing prevocational or similar services under certain Medicaid waiver programs.), As Engrossed

The fiscal implications of the bill cannot be determined due to the uncertainty in required federal approval and the impact it would have on the implementation of  prevocational services. 

The bill would define prevocational services under certain waiver programs as services designed to prepare an individual for paid or unpaid work and achieve a generalized result rather than being job-task oriented.

The bill would require the Health and Human Services Commission (HHSC) to seek a waiver to include prevocational services as a part of the individualized skills and socialization (ISS) services delivered under a waiver program providing long-term services and supports. If the waiver request is not granted, HHSC would be required to establish a similar service authorized by federal law. If the waiver or authorization is granted, HHSC would establish a reimbursement rate for the services. The bill would also require HHSC to establish and monitor clearly stated performance standards applicable to providers providing prevocational or similar services. 

According to information provided by HHSC, additional staff would be needed to comply with the bill. However, the number of full-time equivalent (FTE) positions, technology updates, and client services costs associated with implementing the bill would be dependent on guidance from Centers for Medicare and Medicaid Services (CMS). The costs would be impacted by whether prevocational services are approved to be provided as a part of ISS or if a separate prevocational service would be required.

The costs associated with implementing the bill cannot be determined due to the uncertainty regarding federal approval and the implementation of the services outlined in the bill. 

Local Government Impact

No fiscal implication to units of local government is anticipated.


Source Agencies:
529 Health and Human Services Commission
LBB Staff:
JMc, NPe, ER, CST