| 1 | 1 | | 84R2044 KKR-D |
|---|
| 2 | 2 | | By: Zedler H.B. No. 180 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to the confidentiality of certain information following |
|---|
| 8 | 8 | | the completion of a review conducted by a utilization review agent |
|---|
| 9 | 9 | | or an independent review organization. |
|---|
| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 11 | 11 | | SECTION 1. Section 1305.355, Insurance Code, is amended by |
|---|
| 12 | 12 | | adding Subsection (h) to read as follows: |
|---|
| 13 | 13 | | (h) Notwithstanding Section 4202.009(a), following the |
|---|
| 14 | 14 | | completion of an independent review requested under Subsection (a), |
|---|
| 15 | 15 | | on written request to the independent review organization, a party |
|---|
| 16 | 16 | | to the reviewed medical dispute is entitled to the name and |
|---|
| 17 | 17 | | professional qualifications of any doctor or other health care |
|---|
| 18 | 18 | | practitioner used to perform the independent review. |
|---|
| 19 | 19 | | SECTION 2. Section 4201.557, Insurance Code, is amended to |
|---|
| 20 | 20 | | read as follows: |
|---|
| 21 | 21 | | Sec. 4201.557. REQUIREMENT TO MAINTAIN DATA IN CONFIDENTIAL |
|---|
| 22 | 22 | | MANNER. (a) Except as provided by Subsection (b), a [A] |
|---|
| 23 | 23 | | utilization review agent shall maintain all data concerning a |
|---|
| 24 | 24 | | patient or physician or other health care provider in a |
|---|
| 25 | 25 | | confidential manner that prevents unauthorized disclosure to a |
|---|
| 26 | 26 | | third party. |
|---|
| 27 | 27 | | (b) Following the completion of a utilization review |
|---|
| 28 | 28 | | determination, on written request to the utilization review agent, |
|---|
| 29 | 29 | | a patient, or a patient's representative, is entitled to the name |
|---|
| 30 | 30 | | and professional qualifications of any physician or other |
|---|
| 31 | 31 | | individual health care provider who made the utilization review |
|---|
| 32 | 32 | | determination. |
|---|
| 33 | 33 | | SECTION 3. Section 4202.009, Insurance Code, is amended to |
|---|
| 34 | 34 | | read as follows: |
|---|
| 35 | 35 | | Sec. 4202.009. CONFIDENTIAL INFORMATION. (a) Except as |
|---|
| 36 | 36 | | provided by Subsection (b), information [Information] that reveals |
|---|
| 37 | 37 | | the identity of a physician or other individual health care |
|---|
| 38 | 38 | | provider who makes a review determination for an independent review |
|---|
| 39 | 39 | | organization is confidential. |
|---|
| 40 | 40 | | (b) Following the completion of an independent review |
|---|
| 41 | 41 | | determination, on written request to the independent review |
|---|
| 42 | 42 | | organization, a patient, as defined by Section 4201.002, or the |
|---|
| 43 | 43 | | patient's representative, is entitled to the name and professional |
|---|
| 44 | 44 | | qualifications of any physician or other individual health care |
|---|
| 45 | 45 | | provider who made the independent review determination. |
|---|
| 46 | 46 | | SECTION 4. The change in law made by this Act applies only |
|---|
| 47 | 47 | | to a determination made by a utilization review agent or an |
|---|
| 48 | 48 | | independent review organization with reference to a review that was |
|---|
| 49 | 49 | | requested on or after the effective date of this Act. A |
|---|
| 50 | 50 | | determination made by a utilization review agent or an independent |
|---|
| 51 | 51 | | review organization with reference to a review that was requested |
|---|
| 52 | 52 | | before the effective date of this Act is governed by the law in |
|---|
| 53 | 53 | | effect immediately before the effective date of this Act, and that |
|---|
| 54 | 54 | | law is continued in effect for that purpose. |
|---|
| 55 | 55 | | SECTION 5. This Act takes effect September 1, 2015. |
|---|