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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. STUDY REGARDING COMPREHENSIVE SUBSTANCE |
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ABUSE TREATMENT. (a) The commission shall conduct a study |
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regarding the cost-effectiveness of providing 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. |
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(b) To evaluate the cost-effectiveness of providing |
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comprehensive substance abuse treatment to Medicaid recipients, |
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the commission shall identify and use specific outcome measures. |
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The outcome measures must be measured in three consecutive years, |
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including 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. The study must include, for Medicaid recipients who |
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receive comprehensive substance abuse treatment, at least the |
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following outcome measures: |
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(1) the average annual cost per recipient of a |
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recipient's treatment under the Medicaid program, other than the |
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comprehensive substance abuse treatment, including inpatient |
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services other than inpatient labor and delivery services, |
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outpatient services, and pharmaceutical and ancillary services; |
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(2) the average annual cost per recipient of the |
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comprehensive substance abuse treatment; and |
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(3) the average annual number, per recipient, of: |
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(A) inpatient days; |
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(B) emergency department visits; and |
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(C) outpatient visits. |
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(c) To evaluate cost and utilization trends among Medicaid |
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recipients who are at least 21 years of age and with respect to whom |
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there is no evidence of a substance abuse disorder, the commission |
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shall collect data regarding the outcome measures listed in |
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Subsections (b)(1) and (3) for the same period described by |
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Subsection (b). |
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(d) In conducting the study, the commission shall ensure |
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that outcome data is evaluated 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 collected during the study, the |
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commission shall evaluate cost and utilization trends and whether |
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the provision of comprehensive substance abuse treatment through |
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the state Medicaid program results in an increase in overall |
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Medicaid spending. The commission shall prepare a report of the |
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study data and the commission's determination and, not later than |
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December 1, 2012, submit the report to the governor, the state |
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auditor, and the Legislative Budget Board. |
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(f) If the commission determines that the provision of |
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comprehensive substance abuse treatment through the state Medicaid |
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program has resulted in an increase in overall Medicaid spending, |
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the commission: |
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(1) may not continue to provide those services to a |
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Medicaid recipient who is at least 21 years of age; and |
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(2) shall, in the report required by Subsection (e), |
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recommend the repeal of Section 32.024(ff), Human Resources Code. |
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(g) This section expires January 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 study conducted under Section |
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531.0226, Government Code, a determination is made that the |
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treatment resulted in an increase in overall medical assistance |
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program spending. Comprehensive substance abuse treatment |
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includes assessment, residential detoxification, outpatient |
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detoxification, methadone maintenance, residential services, |
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specialized residential services for women, outpatient chemical |
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dependency counseling, and any other necessary services as |
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determined by the department. |
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SECTION 3. Not later than December 1, 2009, the Health and |
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Human Services Commission shall submit to the Legislative Budget |
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Board for approval the commission's proposed methodology, |
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including outcome measures selected, for the cost-effectiveness |
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study required by Section 531.0226, Government Code, as added by |
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this Act. |
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SECTION 4. 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 5. This Act takes effect September 1, 2009. |