Government Code § 540.0272

Sec. 540.0272. CERTAIN SERVICES PERMITTED IN LIEU OF STATE MEDICAID PLAN SERVICES; ANNUAL REPORT. (a) A contract to which this subchapter applies must contain language permitting the contracting Medicaid managed care organization to offer medically appropriate, cost-effective, evidence-based mental health or substance use services or nutrition counseling and instruction services from a list of services approved by the state Medicaid managed care advisory committee and included in the contract in lieu of services specified in the state Medicaid plan. A recipient is not required to use a service from the list included in the contract in lieu of another service specified in the state Medicaid plan. (b) The commission shall: (1) prepare and submit to the legislature an annual report on the number of times during the preceding year a service from the list included in the contract is used; and (2) consider the actual cost and use of any services from the list included in the contract that are offered by a Medicaid managed care organization when setting the capitation rates for that organization under the contract. (c) In approving the list of nutrition counseling and instruction services that are permitted in lieu of services specified in the state Medicaid plan under this section, the state Medicaid managed care advisory committee may only include nutrition counseling and instruction. The list may not include: (1) home-delivered meals; (2) food prescriptions; or (3) grocery support. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025. Amended by: Acts 2025, 89th Leg., R.S., Ch. 910 (H.B. 26), Sec. 1, eff. September 1, 2025.