Relating to the backdating of referrals for certain managed care health benefit plans.
Impact
If enacted, SB 1723 will amend existing regulations under the Texas Insurance Code to include provisions for backdated referrals in managed care health benefit plans. This change is significant as it can reduce barriers that prevent timely specialty care, particularly in emergencies where every moment counts. The bill's implications extend to various health care plans, including those related to Medicaid and children's health, thus broadening its potential impact across different demographics and health situations.
Summary
Senate Bill 1723 aims to improve access to emergency specialty care by mandating that health plan issuers and administrators accept backdated primary care referrals up to 30 days post-emergency service or supply. The bill addresses a critical issue where certain managed care health benefit plans require patients to obtain a referral from a primary care physician before seeing a specialist, which can complicate care in urgent situations. By allowing for retroactive approval of referrals, the bill is intended to facilitate quicker access to necessary treatment for patients experiencing serious health conditions.
Sentiment
The sentiment around SB 1723 is largely supportive among healthcare professionals and advocates for patient care. Proponents argue that this legislation is necessary to prevent critical delays in care that could lead to severe health consequences. During committee discussions, supporters highlighted the ethical obligation to enable patients to access timely medical interventions. However, there is a recognition of potential concerns from health plan administrators regarding the administrative burdens this bill may introduce.
Contention
The primary contention regarding SB 1723 relates to the administrative implications for health plans and the potential for misuse of backdated referrals. Some critics worry that allowing backdating might lead to abuse or discrepancies in referral practices, impacting the management of patient care and health plan operations. Despite these concerns, advocates maintain that the protections for timely care far outweigh potential administrative challenges, emphasizing the urgency of treating emergent health conditions without unnecessary delays.
Texas Constitutional Statutes Affected
Insurance Code
Chapter 1551. Texas Employees Group Benefits Act
Section: New Section
Chapter 1575. Texas Public School Employees Group Benefits Program
Section: New Section
Chapter 1579. Texas School Employees Uniform Group Health Coverage
Section: New Section
Chapter 1601. Uniform Insurance Benefits Act For Employees Of The University Of Texas System And The Texas A&m University System
Relating to certain group and individual health benefit plans and the provision of health care benefits under health care plans through provider networks.
Relating to payment of certain emergency room physicians for services provided to enrollees of managed care health benefit plans; providing an administrative penalty.