89R5303 AB-D     By: Thompson 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 health behavioral and lifestyle   treatment" means an evidence-based, multi-component behavioral or   lifestyle modification intervention that supports healthy weight   management.                (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)  "Recipient" means a recipient of medical   assistance.                (5)  "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 the chronic disease of obesity,   including:                (1)  intensive health behavioral and lifestyle   treatment services;                 (2)  metabolic and bariatric surgery; and                (3)  anti-obesity medication.          (c)  Intensive health behavior and lifestyle treatment   services 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 may not be more   restrictive than the indications for the medications that are   approved by the United States Food and Drug Administration.          (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.          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.