AI-assisted research summary: The commission must integrate behavioral and physical health services into Medicaid managed care, and managed care organizations must build provider networks and ensure access for specified people.
Sec. 540.0703. BEHAVIORAL HEALTH AND PHYSICAL HEALTH SERVICES. (a) In this section, "behavioral health services" means mental health and substance use disorder services. (b) To the greatest extent possible, the commission shall integrate the following services into the Medicaid managed care program: (1) behavioral health services, including targeted case management and psychiatric rehabilitation services; and (2) physical health services. (c) A Medicaid managed care organization shall: (1) develop a network of public and private behavioral health services providers; and (2) ensure adults with serious mental illness and children with serious emotional disturbance have access to a comprehensive array of services. (d) In implementing this section, the commission shall ensure that: (1) an appropriate assessment tool is used to authorize services; (2) providers are well-qualified and able to provide an appropriate array of services; (3) appropriate performance and quality outcomes are measured; (4) two health home pilot programs are established in two health service areas, representing two distinct regions of this state, for individuals who are diagnosed with: (A) a serious mental illness; and (B) at least one other chronic health condition; (5) a health home established under a pilot program under Subdivision (4) complies with the principles for patient-centered medical homes described in Section 540.0712; and (6) all behavioral health services provided under this section are based on an approach to treatment in which the expected outcome of treatment is recovery. (e) If the commission determines that it is cost-effective and beneficial to recipients, the commission shall include a peer specialist as a benefit to recipients or as a provider type. (f) To the extent of any conflict between this section and any other law relating to behavioral health services, this section prevails. (g) The executive commissioner shall adopt rules necessary to implement this section. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.