89R17043 AB-D     By: Thompson, Bucy H.B. No. 2677     Substitute the following for H.B. No. 2677:     By:  VanDeaver C.S.H.B. No. 2677       A BILL TO BE ENTITLED   AN ACT   relating to Medicaid coverage and reimbursement for the treatment   of obesity and certain diabetes prevention program services.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter B, Chapter 32, Human Resources Code,   is amended by adding Sections 32.02461 and 32.02462 to read as   follows:          Sec. 32.02461.  REIMBURSEMENT FOR TREATING OBESITY. (a) In   this section:                (1)  "Anti-obesity medication" means a prescription   medication approved by the United States Food and Drug   Administration that is indicated for chronic weight management in   an individual who is diagnosed with obesity.                (2)  "Intensive behavioral therapy" means an   evidence-based, multi-component behavioral or lifestyle   modification intervention that:                      (A)  is designed to support healthy weight   management as recommended by current clinical standards of care;   and                      (B)  is provided by a variety of qualified   providers, including licensed dietitians.                (3)  "Metabolic and bariatric surgery" means a surgical   procedure that:                      (A)  alters the stomach, the intestines, or both   to cause weight loss in an individual diagnosed with obesity or an   obesity-related metabolic disorder; and                      (B)  is endorsed by the American Society for   Metabolic and Bariatric Surgery.                (4)  "Obesity" means a chronic disease diagnosed as   having a body mass index (BMI) of 30 or greater.                (5)  "Recipient" means a recipient of medical   assistance.                (6)  "Telehealth service" and "telemedicine medical   service" have the meanings assigned by Section 111.001, Occupations   Code.          (b)  The commission shall ensure that medical assistance   reimbursement is provided for health care services provided to a   recipient for the treatment of obesity, including:                (1)  intensive behavioral therapy;                (2)  metabolic and bariatric surgery; and                (3)  subject to the medication's inclusion in or   provisional availability under the vendor drug program,   anti-obesity medication.          (c)  Intensive behavioral therapy provided under the medical   assistance program may include interventions certified or   recognized by the Centers for Disease Control and Prevention or   recommended by current clinical standards of care. The services   may be provided in person, including in office or in a   community-based setting, or remotely as a telehealth service or   telemedicine medical service.          (d)  The executive commissioner by rule shall establish   medical necessity criteria for anti-obesity medications provided   under the medical assistance program. The criteria:                (1)  may not be more restrictive than the indications   for the medications that are approved by the United States Food and   Drug Administration; and                (2)  must be based on the classes of obesity   established by the Centers for Disease Control and Prevention.          (e)  The commission or a Medicaid managed care organization   may apply utilization management to determine medical necessity for   a health care service authorized under this section only if the   determinations of appropriateness and medical necessity are made in   the same manner as those determinations are made for other health   care services provided under the medical assistance program.          (f)  The executive commissioner shall adopt rules necessary   to implement this section.          Sec. 32.02462.  REIMBURSEMENT FOR DIABETES PREVENTION   PROGRAM SERVICES. (a)  In this section:                (1)  "Diabetes prevention program" means a program   designed to prevent or delay the onset of Type 2 diabetes by   providing a person enrolled in the program a series of structured   behavioral health change sessions based on a curriculum approved by   the Centers for Disease Control and Prevention.                (2)  "Diabetes prevention program supplier" means an   entity included in the National Registry of Recognized Diabetes   Prevention Programs maintained by the Centers for Disease Control   and Prevention.                (3)  "Recipient" means a recipient of medical   assistance.          (b)  The commission shall ensure that medical assistance   reimbursement is provided to a diabetes prevention program supplier   for services provided to a recipient enrolled in a diabetes   prevention program if the recipient:                (1)  meets the program's eligibility requirements; and                (2)  has not previously participated in the program   while a recipient.          (c)  The commission or a Medicaid managed care organization   may use utilization management to determine medical necessity for   services provided by a diabetes prevention program supplier under   this section only if the determination of medical necessity,   including a determination of the appropriateness of the services,   is made in the same manner as the determination is made for other   health care services provided under the medical assistance program.          SECTION 2.  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 3.  As soon as practicable after the date Section   32.02461, Human Resources Code, as added by this Act, is   implemented, the Health and Human Services Commission shall provide   written notice to recipients of medical assistance under Chapter   32, Human Resources Code, regarding the availability of obesity   treatment options under the medical assistance program.          SECTION 4.  This Act takes effect immediately if it receives   a vote of two-thirds of all the members elected to each house, as   provided by Section 39, Article III, Texas Constitution. If this   Act does not receive the vote necessary for immediate effect, this   Act takes effect September 1, 2025.