Texas House Bill HB3412

Texas 2017 - 85th Regular

Caption

Relating to preauthorization by certain health benefit plan issuers of certain covered benefits under the health benefit plan.

Impact

The changes proposed by HB3412 are expected to significantly impact state insurance regulations by streamlining the process through which enrollees receive covered benefits. This bill positions itself as a consumer-protection measure, aiming to reduce barriers to timely medical care. By enacting rules that limit preauthorization, it is anticipated that patients will experience fewer delays in receiving crucial treatments and equipment. The bill's regulations will apply specifically to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2018, making it a crucial timeline for both providers and enrollees in adjusting to the new requirements.

Summary

House Bill 3412 aims to modify the preauthorization requirements imposed by health benefit plan issuers in Texas. Specifically, the bill prohibits health maintenance organizations (HMOs) and insurers from requiring preauthorization for certain healthcare services and benefits, especially in cases where an immediate need is established by a physician or provider. This includes essential items like durable medical equipment, such as crutches and wheelchairs, as well as certain diagnostic testing procedures. The goal is to improve access to necessary healthcare services without the delay often associated with preauthorization processes.

Contention

While the bill has garnered support for its potential to enhance patient access to care, there may be contention arising from the insurance industry regarding compliance costs and implications for medical necessity evaluations. Some stakeholders may argue that removing preauthorization could lead to over-utilization of certain health services, potentially increasing costs for insurers and, subsequently, for consumers. However, proponents argue that these measures are necessary to save lives and expedite access to healthcare services when such needs arise, thereby advocating for the immediate health needs of Texans.