TO:	Honorable Dade Phelan, Speaker of the House, House of Representatives
FROM:	Jerry McGinty, Director, Legislative Budget Board
IN RE:	HB4169 by Price (Relating to providing prevocational or similar services under certain Medicaid waiver programs.), As Passed 2nd House

The bill would define prevocational services under certain waiver programs as services designed to assist a recipient in achieving competitive integrated employment in the community. 

The bill would require the Health and Human Services Commission (HHSC) to seek a waiver to include prevocational services as a part of the individualized skills and socialization (ISS) services delivered under a waiver program providing long-term services and supports. If the waiver request is not granted, HHSC would be required to establish a similar service authorized by federal law. If the waiver or authorization is granted, HHSC would establish a reimbursement rate for the services. The bill would also require HHSC to establish and monitor clearly stated performance standards applicable to providers providing prevocational or similar services. 

According to information provided by HHSC, additional staff would be needed to comply with the bill. However, the number of full-time equivalent (FTE) positions, technology updates, and client services costs associated with implementing the bill would be dependent on guidance from Centers for Medicare and Medicaid Services (CMS). The costs would be impacted by whether prevocational services are approved to be provided as a part of ISS or if a separate prevocational service would be required.

The costs associated with implementing the bill cannot be determined due to the uncertainty regarding federal approval and the implementation of the services outlined in the bill. 

Local Government Impact

No fiscal implication to units of local government is anticipated.