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A BILL TO BE ENTITLED
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AN ACT
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relating to Medicaid coverage and reimbursement for the treatment |
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of obesity and certain diabetes prevention program services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Sections 32.02461 and 32.02462 to read as |
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follows: |
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Sec. 32.02461. REIMBURSEMENT FOR TREATING OBESITY. (a) In |
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this section: |
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(1) "Anti-obesity medication" means a prescription |
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medication approved by the United States Food and Drug |
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Administration that is indicated for chronic weight management in |
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an individual who is diagnosed with obesity. |
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(2) "Intensive health behavioral and lifestyle |
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treatment" means an evidence-based, multi-component behavioral or |
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lifestyle modification intervention that supports healthy weight |
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management. |
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(3) "Metabolic and bariatric surgery" means a surgical |
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procedure that: |
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(A) alters the stomach, the intestines, or both |
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to cause weight loss in an individual diagnosed with obesity or an |
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obesity-related metabolic disorder; and |
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(B) is endorsed by the American Society for |
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Metabolic and Bariatric Surgery. |
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(4) "Recipient" means a recipient of medical |
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assistance. |
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(5) "Telehealth service" and "telemedicine medical |
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service" have the meanings assigned by Section 111.001, Occupations |
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Code. |
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(b) The commission shall ensure that medical assistance |
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reimbursement is provided for health care services provided to a |
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recipient for the treatment of the chronic disease of obesity, |
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including: |
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(1) intensive health behavioral and lifestyle |
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treatment services; |
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(2) metabolic and bariatric surgery; and |
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(3) anti-obesity medication. |
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(c) Intensive health behavior and lifestyle treatment |
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services provided under the medical assistance program may include |
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interventions certified or recognized by the Centers for Disease |
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Control and Prevention or recommended by current clinical standards |
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of care. The services may be provided in person, including in |
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office or in a community-based setting, or remotely as a telehealth |
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service or telemedicine medical service. |
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(d) The executive commissioner by rule shall establish |
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medical necessity criteria for anti-obesity medications provided |
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under the medical assistance program. The criteria may not be more |
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restrictive than the indications for the medications that are |
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approved by the United States Food and Drug Administration. |
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(e) The commission or a Medicaid managed care organization |
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may apply utilization management to determine medical necessity for |
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a health care service authorized under this section only if the |
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determinations of appropriateness and medical necessity are made in |
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the same manner as those determinations are made for other health |
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care services provided under the medical assistance program. |
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(f) The executive commissioner shall adopt rules necessary |
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to implement this section. |
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Sec. 32.02462. REIMBURSEMENT FOR DIABETES PREVENTION |
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PROGRAM SERVICES. (a) In this section: |
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(1) "Diabetes prevention program" means a program |
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designed to prevent or delay the onset of Type 2 diabetes by |
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providing a person enrolled in the program a series of structured |
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behavioral health change sessions based on a curriculum approved by |
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the Centers for Disease Control and Prevention. |
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(2) "Diabetes prevention program supplier" means an |
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entity included in the National Registry of Recognized Diabetes |
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Prevention Programs maintained by the Centers for Disease Control |
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and Prevention. |
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(3) "Recipient" means a recipient of medical |
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assistance. |
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(b) The commission shall ensure that medical assistance |
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reimbursement is provided to a diabetes prevention program supplier |
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for services provided to a recipient enrolled in a diabetes |
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prevention program if the recipient: |
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(1) meets the program's eligibility requirements; and |
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(2) has not previously participated in the program |
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while a recipient. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. As soon as practicable after the date Section |
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32.02461, Human Resources Code, as added by this Act, is |
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implemented, the Health and Human Services Commission shall provide |
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written notice to recipients of medical assistance under Chapter |
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32, Human Resources Code, regarding the availability of obesity |
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treatment options under the medical assistance program. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2025. |