Texas 2015 - 84th Regular

Texas House Bill HB3919 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R13565 SCL-F
2	2	By: Klick H.B. No. 3919
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to prior authorization from a health benefit plan issuer
8	8	to obtain health care services under the health benefit plan.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 32.072(a), Human Resources Code, is
11	11	amended to read as follows:
12	12	(a) Notwithstanding any other law, a recipient of medical
13	13	assistance is entitled to:
14	14	(1) select an ophthalmologist or therapeutic
15	15	optometrist who is a medical assistance provider to provide eye
16	16	health care services, other than surgery, that are within the scope
17	17	of:
18	18	(A) services provided under the medical
19	19	assistance program; and
20	20	(B) the professional specialty practice for
21	21	which the ophthalmologist or therapeutic optometrist is licensed
22	22	and credentialed; and
23	23	(2) have direct access to the selected ophthalmologist
24	24	or therapeutic optometrist for the provision of the nonsurgical
25	25	services without any requirement by the patient or ophthalmologist
26	26	or therapeutic optometrist to obtain:
27	27	(A) a referral from a primary care physician or
28	28	other gatekeeper or health care coordinator; or
29	29	(B) any other prior authorization or
30	30	precertification.
31	31	SECTION 2. Subchapter I, Chapter 843, Insurance Code, is
32	32	amended by adding Section 843.324 to read as follows:
33	33	Sec. 843.324. PRIOR AUTHORIZATION FOR COVERED BENEFIT
34	34	PROHIBITED. Notwithstanding any other law, a health maintenance
35	35	organization may not require a physician or provider to obtain
36	36	prior authorization from the health maintenance organization for
37	37	the health maintenance organization to pay for a covered benefit
38	38	provided to an enrollee.
39	39	SECTION 3. Chapter 1217, Insurance Code, is amended by
40	40	adding Section 1217.008 to read as follows:
41	41	Sec. 1217.008. PRIOR AUTHORIZATION STUDY. (a) The
42	42	department shall conduct a study of:
43	43	(1) the use and effect of prior authorization in this
44	44	state from a health benefit plan issuer to pay for a covered benefit
45	45	for an enrollee; and
46	46	(2) the circumstances that give rise to prior
47	47	authorization from a health benefit plan issuer.
48	48	(b) The commissioner shall implement the results of the
49	49	study by adopting rules regulating, limiting, or prohibiting prior
50	50	authorization practices.
51	51	SECTION 4. Subchapter B, Chapter 1301, Insurance Code, is
52	52	amended by adding Section 1301.070 to read as follows:
53	53	Sec. 1301.070. PRIOR AUTHORIZATION FOR COVERED BENEFIT
54	54	PROHIBITED. Notwithstanding any other law, an insurer may not
55	55	require a physician or health care provider to obtain prior
56	56	authorization from the insurer for the insurer to pay for a covered
57	57	benefit provided to an enrollee.
58	58	SECTION 5. The Texas Department of Insurance shall prepare
59	59	a report of the results of the study conducted under Section
60	60	1217.008, Insurance Code, as added by this Act. Not later than
61	61	December 1, 2016, the department shall provide the report to the
62	62	governor, lieutenant governor, speaker of the house of
63	63	representatives, and chairs of the house and senate standing
64	64	committees with primary jurisdiction over insurance.
65	65	SECTION 6. The changes in law made by this Act apply only to
66	66	a health benefit plan delivered, issued for delivery, or renewed on
67	67	or after January 1, 2016. A health benefit plan delivered, issued
68	68	for delivery, or renewed before January 1, 2016, is governed by the
69	69	law in effect immediately before the effective date of this Act, and
70	70	that law is continued in effect for that purpose.
71	71	SECTION 7. This Act takes effect September 1, 2015.