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A BILL TO BE ENTITLED
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AN ACT
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relating to Medicaid reimbursement for coordinated specialty care |
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for first episode psychosis. |
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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 Section 32.02463 to read as follows: |
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Sec. 32.02463. REIMBURSEMENT FOR COORDINATED SPECIALTY |
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CARE FOR FIRST EPISODE PSYCHOSIS. (a) In this section: |
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(1) "Coordinated specialty care for first episode |
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psychosis" means coordinated specialty care and services provided |
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to an individual who is diagnosed with first episode psychosis, |
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which may include: |
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(A) any element of the treatment model included |
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in the Recovery After an Initial Schizophrenia Episode (RAISE) |
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early treatment program study conducted by the National Institute |
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of Mental Health regarding treatment for psychosis, as completed |
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July 2017, including: |
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(i) psychotherapy; |
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(ii) medication management; |
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(iii) case management; |
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(iv) family education and support; and |
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(v) education and employment support; |
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(B) assertive community treatment as described |
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by the commission's Texas Resilience and Recovery Utilization |
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Management Guidelines: Adult Mental Health Services, as updated in |
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April 2017, or a more recently updated version adopted by the |
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executive commissioner; and |
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(C) peer support services, including: |
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(i) recovery and wellness support; |
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(ii) mentoring; and |
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(iii) advocacy. |
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(2) "First episode psychosis" means the initial onset |
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of psychosis or symptoms associated with psychosis, caused by: |
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(A) medical or neurological conditions; |
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(B) serious mental illness; or |
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(C) substance use. |
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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 provider who provides one or more |
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services classified as coordinated specialty care for first episode |
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psychosis to a recipient experiencing first episode psychosis. |
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(c) A provider is eligible to receive medical assistance |
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reimbursement for the provision of specialty care for first episode |
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psychosis to a recipient only if the provider: |
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(1) has contracted with the commission or a managed |
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care organization to provide that care; and |
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(2) provides the care in a manner that adheres to the |
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fidelity of the applicable treatment model the provider follows. |
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(d) If a psychiatrist or licensed clinical leader of a |
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treatment team is credentialed to provide coordinated specialty |
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care for first episode psychosis under the medical assistance |
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program, each member of the treatment team serving under the |
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credentialed psychiatrist or licensed clinical leader is |
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considered to be credentialed to provide that care. |
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(e) This section may not be construed to require that a |
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provider of coordinated specialty care treatment for first episode |
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psychosis provide every coordinated care service to a recipient in |
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order to receive medical assistance reimbursement. |
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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. This Act takes effect September 1, 2025. |