By: Turner of Tarrant, Kacal H.B. No. 3041
(Senate Sponsor - Buckingham, Menéndez)
(In the Senate - Received from the House May 3, 2019;
May 10, 2019, read first time and referred to Committee on Business &
Commerce; May 21, 2019, reported favorably by the following vote:
Yeas 9, Nays 0; May 21, 2019, sent to printer.)
Click here to see the committee vote
A BILL TO BE ENTITLED
AN ACT
relating to the renewal of a preauthorization for a medical or
health care service.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
by adding Chapter 1222 to read as follows:
CHAPTER 1222. PREAUTHORIZATION FOR MEDICAL OR HEALTH CARE SERVICE
Sec. 1222.0001. DEFINITIONS. In this chapter:
(1) "Health benefit plan" means a plan to which this
chapter applies under Section 1222.0002.
(2) "Health benefit plan issuer" means an entity
authorized under this code or another insurance law of this state
that provides health insurance or health benefits in this state.
(3) "Preauthorization" has the meaning assigned by
Section 1301.001.
Sec. 1222.0002. APPLICABILITY OF CHAPTER. (a) This
chapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(8) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(9) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
(10) the child health plan program under Chapter 62,
Health and Safety Code;
(11) a regional or local health care program operated
under Section 75.104, Health and Safety Code; and
(12) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code.
Sec. 1222.0003. PREAUTHORIZATION RENEWAL REQUEST. A health
benefit plan issuer that requires preauthorization as a condition
of payment for a medical or health care service shall provide a
preauthorization renewal process that allows a renewal of an
existing preauthorization to be requested by a physician or health
care provider at least 60 days before the date the preauthorization
expires.
Sec. 1222.0004. DETERMINATION REQUIRED. If a health
benefit plan issuer receives a preauthorization renewal request
before the existing preauthorization expires, the health benefit
plan issuer shall, if practicable, review the request and issue a
determination indicating whether the medical or health care service
is preauthorized before the existing preauthorization expires.
SECTION 2. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2020. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2020,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 3. This Act takes effect September 1, 2019.
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