| 1 | 1 | | 86R13778 SCL-D |
|---|
| 2 | 2 | | By: J. Johnson of Dallas H.B. No. 3232 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to the authority of health benefit plan issuers to require |
|---|
| 8 | 8 | | utilization review for a health care service provided by network |
|---|
| 9 | 9 | | physicians or providers. |
|---|
| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 11 | 11 | | SECTION 1. Subchapter J, Chapter 843, Insurance Code, is |
|---|
| 12 | 12 | | amended by adding Section 843.355 to read as follows: |
|---|
| 13 | 13 | | Sec. 843.355. UTILIZATION REVIEW FOR PARTICIPATING |
|---|
| 14 | 14 | | PHYSICIAN OR PROVIDER PROHIBITED. A health maintenance |
|---|
| 15 | 15 | | organization may not require utilization review, including a |
|---|
| 16 | 16 | | preauthorization determination that a health care service is |
|---|
| 17 | 17 | | medically necessary and appropriate, of a health care service |
|---|
| 18 | 18 | | provided to an enrollee by a participating physician or provider. |
|---|
| 19 | 19 | | SECTION 2. Subchapter C-1, Chapter 1301, Insurance Code, is |
|---|
| 20 | 20 | | amended by adding Section 1301.140 to read as follows: |
|---|
| 21 | 21 | | Sec. 1301.140. UTILIZATION REVIEW FOR PREFERRED PHYSICIAN |
|---|
| 22 | 22 | | OR PROVIDER PROHIBITED. (a) In this section, "utilization review" |
|---|
| 23 | 23 | | has the meaning assigned by Section 4201.002. |
|---|
| 24 | 24 | | (b) An insurer may not require utilization review, |
|---|
| 25 | 25 | | including preauthorization, of a medical care or health care |
|---|
| 26 | 26 | | service provided to an insured by a preferred physician or |
|---|
| 27 | 27 | | provider. |
|---|
| 28 | 28 | | SECTION 3. Sections 843.348 and 1301.135, Insurance Code, |
|---|
| 29 | 29 | | are repealed. |
|---|
| 30 | 30 | | SECTION 4. The changes in law made by this Act apply only to |
|---|
| 31 | 31 | | a health benefit plan delivered, issued for delivery, or renewed on |
|---|
| 32 | 32 | | or after January 1, 2020. A health benefit plan delivered, issued |
|---|
| 33 | 33 | | for delivery, or renewed before January 1, 2020, is governed by the |
|---|
| 34 | 34 | | law as it existed immediately before the effective date of this Act, |
|---|
| 35 | 35 | | and that law is continued in effect for that purpose. |
|---|
| 36 | 36 | | SECTION 5. This Act takes effect September 1, 2019. |
|---|