Texas House Bill HB3232

Texas 2019 - 86th Regular

Caption

Relating to the authority of health benefit plan issuers to require utilization review for a health care service provided by network physicians or providers.

Impact

By prohibiting utilization reviews for warranted medical services by network providers, HB3232 is set to enhance patient access to healthcare. The reform seeks to ensure that decisions concerning medical necessity are primarily made by healthcare providers rather than insurance companies, which could potentially lead to better health outcomes and patient satisfaction. The changes made by the Act will take effect only for health benefit plans issued or renewed after January 1, 2020, thereby allowing for a transition period for insurers to adapt to these new requirements.

Summary

House Bill 3232 is designed to limit the authority of health benefit plan issuers regarding the utilization review processes for services provided by network physicians or providers. Specifically, the bill prohibits health maintenance organizations (HMOs) from requiring utilization review, including the preauthorization of medical services deemed medically necessary by participating physicians. This piece of legislation aims to streamline patient access to necessary health services by reducing the bureaucratic requirements that can delay care.

Contention

While supporters of HB3232 argue that the bill will eliminate unnecessary delays in access to care, opponents are concerned that removing the utilization review process could result in increased healthcare costs as insurers may need to absorb the higher utilization of services that may not be medically necessary. This raises questions about cost control and the balancing act between providing timely access to care and ensuring that healthcare resources are used appropriately.