Texas Senate Bill SB1187

Texas 2019 - 86th Regular

Caption

Relating to the regulation of utilization review and independent review for health benefit plan coverage.

Impact

The primary impact of SB1187 on state laws relates to the standards and protocols for utilization review agents. By mandating that healthcare review be conducted by state-licensed physicians and ensuring that personnel involved in reviews are appropriately trained and qualified, the bill aims to increase accountability in health benefit plan decisions. This change is expected to reduce the prevalence of denials for medically necessary treatments and improve the overall quality of patient care. The bill also addresses procedural aspects such as appeals, providing a structured process for patients and providers to challenge adverse decisions.

Summary

SB1187 aims to enhance the regulation of utilization review and independent review processes for health benefit plan coverage in Texas. The bill amends several sections of the Insurance Code to ensure that utilization review agents operate under strict guidelines that require the involvement of licensed physicians when making medical necessity determinations. It emphasizes the necessity for proper oversight by physicians, including the requirement that any adverse treatment decisions be reviewed by a physician within the same specialty as the healthcare providers involved. This is designed to ensure that decisions are based on appropriate medical standards and that patients receive fair assessments for their treatment plans.

Contention

Notable points of contention surrounding SB1187 include concerns raised by various stakeholders about the potential for increased administrative burdens on healthcare providers due to the added requirements for physician oversight in utilization reviews. Critics argue that while improving oversight is important, it could lead to delays in patient care if the review processes become overly complicated. On the other hand, supporters of the bill assert that ensuring appropriate medical oversight is crucial to protect patients from arbitrary denials and to uphold the integrity of medical treatment standards.