Bill Text: TX HB2677 | 2025-2026 | 89th Legislature | Introduced
Bill Title: Relating to Medicaid coverage and reimbursement for the treatment of obesity and certain diabetes prevention program services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2025-02-11 - Filed [HB2677 Detail]
Download: Texas-2025-HB2677-Introduced.html
| 89R5303 AB-D | ||
| By: Thompson | H.B. No. 2677 | |
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| 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. | ||
