81R32858 UM-D

By: Hinojosa, et al. S.B. No. 796

Substitute the following for S.B. No. 796:

By: Kolkhorst C.S.S.B. No. 796

A BILL TO BE ENTITLED

AN ACT

relating to the provision and evaluation of comprehensive substance abuse treatment under the state Medicaid program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 531, Government Code, is amended by adding Section 531.0226 to read as follows:

Sec. 531.0226. SUBSTANCE ABUSE TREATMENT EVALUATION. (a) The commission shall monitor the provision of comprehensive substance abuse treatment, as described by Section 32.024(ff), Human Resources Code, to Medicaid recipients who are at least 21 years of age and analyze data relating to the provision of those services. The commission shall provide the data to the Legislative Budget Board in the format and at the times requested by the Legislative Budget Board.

(b) The data analyzed and provided under Subsection (a) must:

(1) be measured in three consecutive years, including the year before the year in which the recipient receives comprehensive substance abuse treatment, the year in which the treatment is first provided to the recipient, and the year following the year in which the treatment is first provided to the recipient; and

(2) include at least the following:

(A) the number of recipients to whom comprehensive substance abuse treatment is provided;

(B) the type of substance abuse treatment provided;

(C) the average annual cost per recipient of treatment under the Medicaid program, other than the comprehensive substance abuse treatment, including inpatient services other than inpatient labor and delivery services, emergency department services, outpatient services, and pharmaceutical and ancillary services;

(D) the average annual cost per recipient of the comprehensive substance abuse treatment; and

(E) the average annual number per recipient of:

(i) inpatient days;

(ii) emergency department visits; and

(iii) outpatient visits.

(c) The commission shall collect the data listed in Subsections (b)(2)(C) and (E) for Medicaid recipients who are at least 21 years of age and with respect to whom there is no evidence of a substance abuse disorder for the same period described by Subsection (b).

(d) The commission shall ensure that data is analyzed using:

(1) appropriate demographic categories, including recipient age, disability, and income; and

(2) the type of service delivery model through which the recipient received services through Medicaid, including the fee-for-service, primary care case management, and health maintenance organization models.

(e) Using the data provided by the commission, the Legislative Budget Board shall evaluate cost and utilization trends and whether the provision of comprehensive substance abuse treatment through the state Medicaid program results in an increase in overall Medicaid spending. Not later than February 1, 2013, the Legislative Budget Board shall prepare and publish a report of the data. The Legislative Budget Board shall provide a draft of the report to the commission before publishing the report.

(f) If the Legislative Budget Board determines that the provision of comprehensive substance abuse treatment through the state Medicaid program has resulted in an increase in overall Medicaid spending, the commission may not continue to provide those services to a Medicaid recipient who is at least 21 years of age.

(g) This section expires March 1, 2013.

SECTION 2. Section 32.024, Human Resources Code, is amended by adding Subsection (ff) to read as follows:

(ff) Except as otherwise provided by this subsection, the department shall provide comprehensive substance abuse treatment under the medical assistance program to a person who is at least 21 years of age, has a substance abuse disorder, and otherwise qualifies for medical assistance. The department may not provide the treatment if, based on the data evaluated under Section 531.0226, Government Code, the Legislative Budget Board determines that the treatment resulted in an increase in overall medical assistance program spending. Comprehensive substance abuse treatment includes assessment, residential detoxification, outpatient detoxification, medication-assisted treatment, residential services, specialized residential services for women, outpatient chemical dependency counseling, and any other necessary services as determined by the department.

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, 2009.