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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision and evaluation of comprehensive substance |
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abuse treatment under the state Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0226 to read as follows: |
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Sec. 531.0226. SUBSTANCE ABUSE TREATMENT EVALUATION. |
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(a) The commission shall monitor the provision of comprehensive |
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substance abuse treatment, as described by Section 32.024(ff), |
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Human Resources Code, to Medicaid recipients who are at least 21 |
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years of age and analyze data relating to the provision of those |
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services. The commission shall provide the data to the Legislative |
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Budget Board in the format and at the times requested by the |
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Legislative Budget Board. |
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(b) The data analyzed and provided under Subsection (a) |
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must: |
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(1) be measured in three consecutive years, including |
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the year before the year in which the recipient receives |
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comprehensive substance abuse treatment, the year in which the |
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treatment is first provided to the recipient, and the year |
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following the year in which the treatment is first provided to the |
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recipient; and |
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(2) include at least the following: |
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(A) the number of recipients to whom |
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comprehensive substance abuse treatment is provided; |
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(B) the type of substance abuse treatment |
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provided; |
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(C) the average annual cost per recipient of |
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treatment under the Medicaid program, other than the comprehensive |
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substance abuse treatment, including inpatient services other than |
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inpatient labor and delivery services, emergency department |
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services, outpatient services, and pharmaceutical and ancillary |
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services; |
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(D) the average annual cost per recipient of the |
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comprehensive substance abuse treatment; and |
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(E) the average annual number per recipient of: |
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(i) inpatient days; |
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(ii) emergency department visits; and |
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(iii) outpatient visits. |
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(c) The commission shall collect the data listed in |
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Subsections (b)(2)(C) and (E) for Medicaid recipients who are at |
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least 21 years of age and with respect to whom there is no evidence |
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of a substance abuse disorder for the same period described by |
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Subsection (b). |
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(d) The commission shall ensure that data is analyzed using: |
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(1) appropriate demographic categories, including |
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recipient age, disability, and income; and |
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(2) the type of service delivery model through which |
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the recipient received services through Medicaid, including the |
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fee-for-service, primary care case management, and health |
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maintenance organization models. |
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(e) Using the data provided by the commission, the |
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Legislative Budget Board shall evaluate cost and utilization trends |
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and whether the provision of comprehensive substance abuse |
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treatment through the state Medicaid program results in an increase |
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in overall Medicaid spending. Not later than February 1, 2013, the |
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Legislative Budget Board shall prepare and publish a report of the |
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data. The Legislative Budget Board shall provide a draft of the |
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report to the commission before publishing the report. |
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(f) If the Legislative Budget Board determines that the |
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provision of comprehensive substance abuse treatment through the |
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state Medicaid program has resulted in an increase in overall |
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Medicaid spending, the commission may not continue to provide those |
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services to a Medicaid recipient who is at least 21 years of age. |
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(g) This section expires March 1, 2013. |
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SECTION 2. Section 32.024, Human Resources Code, is amended |
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by adding Subsection (ff) to read as follows: |
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(ff) Except as otherwise provided by this subsection, the |
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department shall provide comprehensive substance abuse treatment |
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under the medical assistance program to a person who is at least 21 |
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years of age, has a substance abuse disorder, and otherwise |
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qualifies for medical assistance. The department may not provide |
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the treatment if, based on the data evaluated under Section |
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531.0226, Government Code, the Legislative Budget Board determines |
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that the treatment resulted in an increase in overall medical |
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assistance program spending. Comprehensive substance abuse |
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treatment includes assessment, residential detoxification, |
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outpatient detoxification, medication-assisted treatment, |
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residential services, specialized residential services for women, |
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outpatient chemical dependency counseling, and any other necessary |
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services as determined by the department. |
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SECTION 3. 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 4. This Act takes effect September 1, 2009. |