Texas House Bill HB3812

Texas 2025 - 89th Regular

• Filed: 3/5/25
• Out of House Committee: 5/6/25
• Voted on by House: 5/15/25
• Out of Senate Committee: 5/23/25
• Voted on by Senate: 5/27/25

Caption

Relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.

Impact

The implications of HB 3812 are significant in the context of how health insurers manage preauthorization requests. The bill mandates that insurers cannot require prior authorizations for services that have been mostly approved by insurers in the past, ensuring that physicians and healthcare providers have a smoother interaction with insurance entities. This aims to reduce administrative burdens and delays in patient care while making the system more responsive to medical necessity by subjecting preauthorization evaluations to specified benchmarks of approval rates.

Summary

House Bill 3812 aims to amend the Insurance Code specifically focusing on health benefit plan preauthorization requirements for certain healthcare services. The bill stipulates that utilization reviews of these services must be conducted under the direction of a licensed physician who cannot be engaged in administrative medicine. This change is intended to enhance the efficiency and appropriateness of the preauthorization process while ensuring the oversight remains aligned with medical standards and practices.

Sentiment

The sentiment around HB 3812 appears to be predominantly positive among healthcare providers who support easing the preauthorization burdens that can delay necessary care for patients. However, concerns have been raised about how these changes may affect the oversight capabilities of insurers, particularly in ensuring that medical services are truly necessary and in preventing inappropriate claims. Thus, while many see the bill as a progressive step toward streamlined healthcare delivery, there are apprehensions regarding potential impacts on cost control and patient safety.

Contention

Notable points of contention surrounding the bill involve concerns from some insurance representatives regarding the potential for increased costs if preauthorization exemptions lead to an increase in unnecessary healthcare service utilization. Opponents argue that the bill may inadvertently lower the scrutiny placed on the necessity of treatments, potentially resulting in greater expenses for both insurers and consumers. As the bill moves through legislative processes, these arguments reflect a broader debate on balancing patient access with cost management in healthcare.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 4201. Utilization Review Agents
  • Section: 152
  • Section: New Section
  • Section: 602
  • Section: 603
  • Section: 656
  • Section: 658
  • Section: 152
  • Section: 651
  • Section: 653
  • Section: 655
  • Section: 656
  • Section: 658
  • Section: 659
  • Section: New Section
  • Section: 152
  • Section: 651
  • Section: 653
  • Section: 655
  • Section: 656
  • Section: 658
  • Section: 659
  • Section: New Section
  • Section: 152
  • Section: 651
  • Section: 653
  • Section: 655
  • Section: 656
  • Section: 658
  • Section: 659
  • Section: New Section
  • Section: 152
  • Section: 651
  • Section: 653
  • Section: 655
  • Section: 656
  • Section: 658
  • Section: 659
  • Section: New Section
  • Section: 152
  • Section: 651
  • Section: 653
  • Section: 655
  • Section: 658
  • Section: 659
  • Section: New Section
  • Section: 655
  • Section: 656
  • Section: 658
  • Section: 659
  • Section: New Section

Occupations Code

• Chapter 151. General Provisions
  • Section: New Section

• Chapter 155. License To Practice Medicine
  • Section: 009
  • Section: 009
  • Section: 009