Texas 2017 - 85th Regular

Texas House Bill HB3412 Compare Versions

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

Old	New	Differences
1	1	85R13312 BEE-D
2	2	By: Shaheen H.B. No. 3412
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to preauthorization by certain health benefit plan issuers
8	8	of certain covered benefits under the health benefit plan.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
11	11	amended by adding Section 843.324 to read as follows:
12	12	Sec. 843.324. PREAUTHORIZATION OF CERTAIN COVERED
13	13	BENEFITS; WAIVER. (a) The commissioner by rule shall:
14	14	(1) specify covered benefits provided to an enrollee
15	15	under a health care plan for which the health maintenance
16	16	organization is prohibited from requiring a physician or provider
17	17	to obtain preauthorization from the health maintenance
18	18	organization in order for the health maintenance organization to
19	19	pay for the benefit; and
20	20	(2) establish a simple procedure under which a
21	21	physician or provider may obtain a waiver of a health maintenance
22	22	organization's preauthorization requirement for a covered benefit
23	23	under circumstances specified by rule.
24	24	(b) Rules adopted under Subsection (a) must provide that the
25	25	following covered benefits are not subject to preauthorization or
26	26	are subject to a waiver of preauthorization requirements:
27	27	(1) if a physician or provider determines that an
28	28	enrollee has an immediate need for the covered benefit:
29	29	(A) durable medical equipment, including
30	30	crutches and wheelchairs; or
31	31	(B) diagnostic testing; or
32	32	(2) another health care service under circumstances
33	33	that take into account:
34	34	(A) symptoms displayed by the enrollee;
35	35	(B) the relationship between the physician or
36	36	provider and the enrollee, including the length of the
37	37	relationship; and
38	38	(C) the professional experience of the physician
39	39	or provider.
40	40	SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is
41	41	amended by adding Section 1301.070 to read as follows:
42	42	Sec. 1301.070. PREAUTHORIZATION OF CERTAIN COVERED
43	43	BENEFITS; WAIVER. (a) The commissioner by rule shall:
44	44	(1) specify covered benefits provided to an insured
45	45	under a preferred provider benefit plan for which the insurer is
46	46	prohibited from requiring a physician or health care provider to
47	47	obtain preauthorization from the insurer in order for the insurer
48	48	to pay for the benefit; and
49	49	(2) establish a simple procedure under which a
50	50	physician or health care provider may obtain a waiver of an
51	51	insurer's preauthorization requirement for a covered benefit under
52	52	circumstances specified by rule.
53	53	(b) Rules adopted under Subsection (a) must provide that the
54	54	following covered benefits are not subject to preauthorization or
55	55	are subject to a waiver of preauthorization requirements:
56	56	(1) if a physician or health care provider determines
57	57	that an insured has an immediate need for the covered benefit:
58	58	(A) durable medical equipment, including
59	59	crutches and wheelchairs; or
60	60	(B) diagnostic testing; or
61	61	(2) another health care service under circumstances
62	62	that take into account:
63	63	(A) symptoms displayed by the insured;
64	64	(B) the relationship between the physician or
65	65	health care provider and the insured, including the length of the
66	66	relationship; and
67	67	(C) the professional experience of the physician
68	68	or health care provider.
69	69	SECTION 3. The changes in law made by this Act apply only to
70	70	a health benefit plan delivered, issued for delivery, or renewed on
71	71	or after January 1, 2018. A health benefit plan delivered, issued
72	72	for delivery, or renewed before January 1, 2018, is governed by the
73	73	law as it existed immediately before the effective date of this Act,
74	74	and that law is continued in effect for that purpose.
75	75	SECTION 4. This Act takes effect September 1, 2017.