Texas 2019 - 86th Regular

Texas Senate Bill SB1742 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 1742
	1	+	By: Menéndez, et al. S.B. No. 1742
	2	+	(J. Johnson of Dallas)
2	3
3	4
	5	+	A BILL TO BE ENTITLED
4	6		AN ACT
5		-	relating to physician and health care provider directories,
6		-	preauthorization, utilization review, independent review, and peer
7		-	review for certain health benefit plans and workers' compensation
8		-	coverage.
	7	+	relating to physician and health care provider directories for
	8	+	certain health benefit plans.
9	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10		-	ARTICLE 1. HEALTH CARE PROVIDER DIRECTORIES
11		-	SECTION 1.01. Section 1451.501, Insurance Code, is amended
12		-	by amending Subdivision (1) and adding Subdivisions (1-a) and (1-b)
13		-	to read as follows:
	10	+	SECTION 1. Section 1451.501, Insurance Code, is amended by
	11	+	amending Subdivision (1) and adding Subdivisions (1-a) and (1-b) to
	12	+	read as follows:
14	13		(1) "Facility" has the meaning assigned by Section
15	14		324.001, Health and Safety Code.
16	15		(1-a) "Facility-based physician" means a radiologist,
17	16		anesthesiologist, pathologist, emergency department physician,
18	17		neonatologist, or assistant surgeon:
19	18		(A) to whom a facility has granted clinical
20	19		privileges; and
21	20		(B) who provides services to patients of the
22	21		facility under those clinical privileges.
23	22		(1-b) "Health care provider" means a practitioner,
24	23		institutional provider, or other person or organization that
25	24		furnishes health care services and that is licensed or otherwise
26	25		authorized to practice in this state. The term includes a
27	26		pharmacist, pharmacy, hospital, nursing home, or other medical or
28	27		health-related service facility that provides care for the sick or
29	28		injured or other care. The term does not include a physician.
30		-	SECTION ~~1.02~~. Section 1451.504, Insurance Code, is amended
31		-	by amending Subsection (b) and adding Subsections (c) and (d) to
32		-	~~read~~ as follows:
	29	+	SECTION 2. Section 1451.504, Insurance Code, is amended by
	30	+	amending Subsection (b) and adding Subsections (c) and (d) to read
	31	+	as follows:
33	32		(b) The directory must include the name, street address,
34	33		specialty, if any, and telephone number of each physician and
35	34		health care provider described by Subsection (a) and indicate
36	35		whether the physician or provider is accepting new patients.
37	36		(c) For each health care provider that is a facility
38	37		included in the directory under this section, the directory must:
39	38		(1) list under the facility name separate headings for
40	39		radiologists, anesthesiologists, pathologists, emergency
41	40		department physicians, neonatologists, and assistant surgeons;
42	41		(2) list under each heading described by Subdivision
43	42		(1) each facility-based physician described by Subsection (a)
44	43		practicing in the specialty corresponding with that heading that is
45	44		a preferred provider, exclusive provider, or network physician;
46	45		(3) for the facility and each facility-based physician
47	46		described by Subdivision (2), clearly indicate each health benefit
48	47		plan issued by the issuer that may provide coverage for the services
49	48		provided by that facility or physician; and
50	49		(4) include the facility in a listing of all
51	50		facilities included in the directory indicating:
52	51		(A) the name of the facility;
53	52		(B) the municipality in which the facility is
54	53		located or county in which the facility is located if the facility
55	54		is in the unincorporated area of the county;
56	55		(C) for each specialty of facility-based
57	56		physician practicing at the facility, the name, street address, and
58	57		telephone number of any facility-based physician that is a
59	58		preferred provider, exclusive provider, or network physician or of
60	59		the physician group in which the facility-based physician
61	60		practices;
62	61		(D) each health benefit plan issued by the issuer
63	62		that may provide coverage for the services provided by the
64	63		facility; and
65	64		(E) each health benefit plan issued by the issuer
66	65		that may provide coverage for the services provided by each
67	66		facility-based physician group.
68	67		(d) The directory must list a facility-based physician
69	68		individually and, if the physician belongs to a physician group, as
70	69		part of the physician group.
71		-	SECTION ~~1.03~~. Section 1451.505(c), Insurance Code, is
72		-	~~amended~~ to read as follows:
	70	+	SECTION 3. Section 1451.505(c), Insurance Code, is amended
	71	+	to read as follows:
73	72		(c) The directory must be:
74	73		(1) electronically searchable by physician or health
75	74		care provider name, specialty, if any, facility, and location; and
76	75		(2) publicly accessible without necessity of
77	76		providing a password, a user name, or personally identifiable
78	77		information.
79		-	ARTICLE 2. PREAUTHORIZATION
80		-	SECTION 2.01. Section 843.348(b), Insurance Code, is
81		-	amended to read as follows:
82		-	(b) A health maintenance organization that uses a
83		-	preauthorization process for health care services shall provide
84		-	each participating physician or provider, not later than the fifth
85		-	[10th] business day after the date a request is made, a list of
86		-	health care services that [do not] require preauthorization and
87		-	information concerning the preauthorization process.
88		-	SECTION 2.02. Subchapter J, Chapter 843, Insurance Code, is
89		-	amended by adding Sections 843.3481, 843.3482, and 843.3483 to read
90		-	as follows:
91		-	Sec. 843.3481. POSTING OF PREAUTHORIZATION REQUIREMENTS.
92		-	(a) A health maintenance organization that uses a
93		-	preauthorization process for health care services shall make the
94		-	requirements and information about the preauthorization process
95		-	readily accessible to enrollees, physicians, providers, and the
96		-	general public by posting the requirements and information on the
97		-	health maintenance organization's Internet website.
98		-	(b) The preauthorization requirements and information
99		-	described by Subsection (a) must:
100		-	(1) be posted:
101		-	(A) except as provided by Subsection (c) or (d),
102		-	conspicuously in a location on the Internet website that does not
103		-	require the use of a log-in or other input of personal information
104		-	to view the information; and
105		-	(B) in a format that is easily searchable and
106		-	accessible;
107		-	(2) except for the screening criteria under
108		-	Subdivision (4)(C), be written in plain language that is easily
109		-	understandable by enrollees, physicians, providers, and the
110		-	general public;
111		-	(3) include a detailed description of the
112		-	preauthorization process and procedure; and
113		-	(4) include an accurate and current list of the health
114		-	care services for which the health maintenance organization
115		-	requires preauthorization that includes the following information
116		-	specific to each service:
117		-	(A) the effective date of the preauthorization
118		-	requirement;
119		-	(B) a list or description of any supporting
120		-	documentation that the health maintenance organization requires
121		-	from the physician or provider ordering or requesting the service
122		-	to approve a request for that service;
123		-	(C) the applicable screening criteria, which may
124		-	include Current Procedural Terminology codes and International
125		-	Classification of Diseases codes; and
126		-	(D) statistics regarding preauthorization
127		-	approval and denial rates for the service in the preceding calendar
128		-	year, including statistics in the following categories:
129		-	(i) physician or provider type and
130		-	specialty, if any;
131		-	(ii) indication offered;
132		-	(iii) reasons for request denial;
133		-	(iv) denials overturned on internal appeal;
134		-	(v) denials overturned by an independent
135		-	review organization; and
136		-	(vi) total annual preauthorization
137		-	requests, approvals, and denials for the service.
138		-	(c) This section may not be construed to require a health
139		-	maintenance organization to provide specific information that
140		-	would violate any applicable copyright law or licensing agreement.
141		-	To comply with a posting requirement described by Subsection (b), a
142		-	health maintenance organization may, instead of making that
143		-	information publicly available on the health maintenance
144		-	organization's Internet website, supply a summary of the withheld
145		-	information sufficient to allow a licensed physician or provider,
146		-	as applicable for the specific service, who has sufficient training
147		-	and experience related to the service to understand the basis for
148		-	the health maintenance organization's medical necessity or
149		-	appropriateness determinations.
150		-	(d) If a requirement or information described by Subsection
151		-	(a) is licensed, proprietary, or copyrighted material that the
152		-	health maintenance organization has received from a third party
153		-	with which the health maintenance organization has contracted, to
154		-	comply with a posting requirement described by Subsection (b), the
155		-	health maintenance organization may, instead of making that
156		-	information publicly available on the health maintenance
157		-	organization's Internet website, provide the material to a
158		-	physician or provider who submits a preauthorization request using
159		-	a nonpublic secured Internet website link or other protected,
160		-	nonpublic electronic means.
161		-	Sec. 843.3482. CHANGES TO PREAUTHORIZATION REQUIREMENTS.
162		-	(a) Except as provided by Subsection (b), not later than the 60th
163		-	day before the date a new or amended preauthorization requirement
164		-	takes effect, a health maintenance organization that uses a
165		-	preauthorization process for health care services shall provide
166		-	notice of the new or amended preauthorization requirement and
167		-	disclose the new or amended requirement in the health maintenance
168		-	organization's newsletter or network bulletin, if any, and on the
169		-	health maintenance organization's Internet website.
170		-	(b) For a change in a preauthorization requirement or
171		-	process that removes a service from the list of health care services
172		-	requiring preauthorization or amends a preauthorization
173		-	requirement in a way that is less burdensome to enrollees or
174		-	participating physicians or providers, a health maintenance
175		-	organization shall provide notice of the change in the
176		-	preauthorization requirement and disclose the change in the health
177		-	maintenance organization's newsletter or network bulletin, if any,
178		-	and on the health maintenance organization's Internet website not
179		-	later than the fifth day before the date the change takes effect.
180		-	(c) Not later than the fifth day before the date a new or
181		-	amended preauthorization requirement takes effect, a health
182		-	maintenance organization shall update its Internet website to
183		-	disclose the change to the health maintenance organization's
184		-	preauthorization requirements or process and the date and time the
185		-	change is effective.
186		-	Sec. 843.3483. REMEDY FOR NONCOMPLIANCE. In addition to
187		-	any other penalty or remedy provided by law, a health maintenance
188		-	organization that uses a preauthorization process for health care
189		-	services that violates this subchapter with respect to a required
190		-	publication, notice, or response regarding its preauthorization
191		-	requirements, including by failing to comply with any applicable
192		-	deadline for the publication, notice, or response, must provide an
193		-	expedited appeal under Section 4201.357 for any health care service
194		-	affected by the violation.
195		-	SECTION 2.03. Section 1301.135(a), Insurance Code, is
196		-	amended to read as follows:
197		-	(a) An insurer that uses a preauthorization process for
198		-	medical care or [and] health care services shall provide to each
199		-	preferred provider, not later than the fifth [10th] business day
200		-	after the date a request is made, a list of medical care and health
201		-	care services that require preauthorization and information
202		-	concerning the preauthorization process.
203		-	SECTION 2.04. Subchapter C-1, Chapter 1301, Insurance Code,
204		-	is amended by adding Sections 1301.1351, 1301.1352, and 1301.1353
205		-	to read as follows:
206		-	Sec. 1301.1351. POSTING OF PREAUTHORIZATION REQUIREMENTS.
207		-	(a) An insurer that uses a preauthorization process for medical
208		-	care or health care services shall make the requirements and
209		-	information about the preauthorization process readily accessible
210		-	to insureds, physicians, health care providers, and the general
211		-	public by posting the requirements and information on the insurer's
212		-	Internet website.
213		-	(b) The preauthorization requirements and information
214		-	described by Subsection (a) must:
215		-	(1) be posted:
216		-	(A) except as provided by Subsection (c) or (d),
217		-	conspicuously in a location on the Internet website that does not
218		-	require the use of a log-in or other input of personal information
219		-	to view the information; and
220		-	(B) in a format that is easily searchable and
221		-	accessible;
222		-	(2) except for the screening criteria under
223		-	Subdivision (4)(C), be written in plain language that is easily
224		-	understandable by insureds, physicians, health care providers, and
225		-	the general public;
226		-	(3) include a detailed description of the
227		-	preauthorization process and procedure; and
228		-	(4) include an accurate and current list of medical
229		-	care and health care services for which the insurer requires
230		-	preauthorization that includes the following information specific
231		-	to each service:
232		-	(A) the effective date of the preauthorization
233		-	requirement;
234		-	(B) a list or description of any supporting
235		-	documentation that the insurer requires from the physician or
236		-	health care provider ordering or requesting the service to approve
237		-	a request for the service;
238		-	(C) the applicable screening criteria, which may
239		-	include Current Procedural Terminology codes and International
240		-	Classification of Diseases codes; and
241		-	(D) statistics regarding the insurer's
242		-	preauthorization approval and denial rates for the medical care or
243		-	health care service in the preceding calendar year, including
244		-	statistics in the following categories:
245		-	(i) physician or health care provider type
246		-	and specialty, if any;
247		-	(ii) indication offered;
248		-	(iii) reasons for request denial;
249		-	(iv) denials overturned on internal appeal;
250		-	(v) denials overturned by an independent
251		-	review organization; and
252		-	(vi) total annual preauthorization
253		-	requests, approvals, and denials for the service.
254		-	(c) This section may not be construed to require an insurer
255		-	to provide specific information that would violate any applicable
256		-	copyright law or licensing agreement. To comply with a posting
257		-	requirement described by Subsection (b), an insurer may, instead of
258		-	making that information publicly available on the insurer's
259		-	Internet website, supply a summary of the withheld information
260		-	sufficient to allow a licensed physician or other health care
261		-	provider, as applicable for the specific service, who has
262		-	sufficient training and experience related to the service to
263		-	understand the basis for the insurer's medical necessity or
264		-	appropriateness determinations.
265		-	(d) If a requirement or information described by Subsection
266		-	(a) is licensed, proprietary, or copyrighted material that the
267		-	insurer has received from a third party with which the insurer has
268		-	contracted, to comply with a posting requirement described by
269		-	Subsection (b), the insurer may, instead of making that information
270		-	publicly available on the insurer's Internet website, provide the
271		-	material to a physician or health care provider who submits a
272		-	preauthorization request using a nonpublic secured Internet
273		-	website link or other protected, nonpublic electronic means.
274		-	(e) The provisions of this section may not be waived,
275		-	voided, or nullified by contract.
276		-	Sec. 1301.1352. CHANGES TO PREAUTHORIZATION REQUIREMENTS.
277		-	(a) Except as provided by Subsection (b), not later than the 60th
278		-	day before the date a new or amended preauthorization requirement
279		-	takes effect, an insurer that uses a preauthorization process for
280		-	medical care or health care services shall provide notice of the new
281		-	or amended preauthorization requirement and disclose the new or
282		-	amended requirement in the insurer's newsletter or network
283		-	bulletin, if any, and on the insurer's Internet website.
284		-	(b) For a change in a preauthorization requirement or
285		-	process that removes a service from the list of medical care or
286		-	health care services requiring preauthorization or amends a
287		-	preauthorization requirement in a way that is less burdensome to
288		-	insureds, physicians, or health care providers, an insurer shall
289		-	provide notice of the change in the preauthorization requirement
290		-	and disclose the change in the insurer's newsletter or network
291		-	bulletin, if any, and on the insurer's Internet website not later
292		-	than the fifth day before the date the change takes effect.
293		-	(c) Not later than the fifth day before the date a new or
294		-	amended preauthorization requirement takes effect, an insurer
295		-	shall update its Internet website to disclose the change to the
296		-	insurer's preauthorization requirements or process and the date and
297		-	time the change is effective.
298		-	(d) The provisions of this section may not be waived,
299		-	voided, or nullified by contract.
300		-	Sec. 1301.1353. REMEDY FOR NONCOMPLIANCE. (a) In addition
301		-	to any other penalty or remedy provided by law, an insurer that uses
302		-	a preauthorization process for medical care or health care services
303		-	that violates this subchapter with respect to a required
304		-	publication, notice, or response regarding its preauthorization
305		-	requirements, including by failing to comply with any applicable
306		-	deadline for the publication, notice, or response, must provide an
307		-	expedited appeal under Section 4201.357 for any medical care or
308		-	health care service affected by the violation.
309		-	(b) The provisions of this section may not be waived,
310		-	voided, or nullified by contract.
311		-	ARTICLE 3. UTILIZATION, INDEPENDENT, AND PEER REVIEW
312		-	SECTION 3.01. Section 4201.002(12), Insurance Code, is
313		-	amended to read as follows:
314		-	(12) "Provider of record" means the physician or other
315		-	health care provider with primary responsibility for the health
316		-	care[, treatment, and] services provided to or requested on behalf
317		-	of an enrollee or the physician or other health care provider that
318		-	has provided or has been requested to provide the health care
319		-	services to the enrollee. The term includes a health care facility
320		-	where the health care services are [if treatment is] provided on an
321		-	inpatient or outpatient basis.
322		-	SECTION 3.02. Sections 4201.151 and 4201.152, Insurance
323		-	Code, are amended to read as follows:
324		-	Sec. 4201.151. UTILIZATION REVIEW PLAN. A utilization
325		-	review agent's utilization review plan, including reconsideration
326		-	and appeal requirements, must be reviewed by a physician licensed
327		-	to practice medicine in this state and conducted in accordance with
328		-	standards developed with input from appropriate health care
329		-	providers and approved by a physician licensed to practice medicine
330		-	in this state.
331		-	Sec. 4201.152. UTILIZATION REVIEW UNDER [DIRECTION OF]
332		-	PHYSICIAN. A utilization review agent shall conduct utilization
333		-	review under the direction of a physician licensed to practice
334		-	medicine in this [by a] state [licensing agency in the United
335		-	States].
336		-	SECTION 3.03. Sections 4201.155, 4201.206, and 4201.251,
337		-	Insurance Code, are amended to read as follows:
338		-	Sec. 4201.155. LIMITATION ON NOTICE REQUIREMENTS AND REVIEW
339		-	PROCEDURES. (a) A utilization review agent may not establish or
340		-	impose a notice requirement or other review procedure that is
341		-	contrary to the requirements of the health insurance policy or
342		-	health benefit plan.
343		-	(b) This section may not be construed to release a health
344		-	insurance policy or health benefit plan from full compliance with
345		-	this chapter or other applicable law.
346		-	Sec. 4201.206. OPPORTUNITY TO DISCUSS TREATMENT BEFORE
347		-	ADVERSE DETERMINATION. (a) Subject to Subsection (b) and the
348		-	notice requirements of Subchapter G, before an adverse
349		-	determination is issued by a utilization review agent who questions
350		-	the medical necessity, the [or] appropriateness, or the
351		-	experimental or investigational nature[,] of a health care service,
352		-	the agent shall provide the health care provider who ordered,
353		-	requested, provided, or is to provide the service a reasonable
354		-	opportunity to discuss with a physician licensed to practice
355		-	medicine the patient's treatment plan and the clinical basis for
356		-	the agent's determination.
357		-	(b) If the health care service described by Subsection (a)
358		-	was ordered, requested, or provided, or is to be provided by a
359		-	physician, the opportunity described by that subsection must be
360		-	with a physician licensed to practice medicine.
361		-	Sec. 4201.251. DELEGATION OF UTILIZATION REVIEW. A
362		-	utilization review agent may delegate utilization review to
363		-	qualified personnel in the hospital or other health care facility
364		-	in which the health care services to be reviewed were or are to be
365		-	provided. The delegation does not release the agent from the full
366		-	responsibility for compliance with this chapter or other applicable
367		-	law, including the conduct of those to whom utilization review has
368		-	been delegated.
369		-	SECTION 3.04. Sections 4201.252(a) and (b), Insurance Code,
370		-	are amended to read as follows:
371		-	(a) Personnel employed by or under contract with a
372		-	utilization review agent to perform utilization review must be
373		-	appropriately trained and qualified and meet the requirements of
374		-	this chapter and other applicable law, including applicable
375		-	licensing requirements.
376		-	(b) Personnel, other than a physician licensed to practice
377		-	medicine, who obtain oral or written information directly from a
378		-	patient's physician or other health care provider regarding the
379		-	patient's specific medical condition, diagnosis, or treatment
380		-	options or protocols must be a nurse, physician assistant, or other
381		-	health care provider qualified to provide the requested service.
382		-	SECTION 3.05. Section 4201.356, Insurance Code, is amended
383		-	to read as follows:
384		-	Sec. 4201.356. DECISION BY PHYSICIAN REQUIRED; SPECIALTY
385		-	REVIEW. (a) The procedures for appealing an adverse determination
386		-	must provide that a physician licensed to practice medicine makes
387		-	the decision on the appeal, except as provided by Subsection (b).
388		-	(b) If not later than the 10th working day after the date an
389		-	appeal is requested or denied the enrollee's health care provider
390		-	requests [states in writing good cause for having] a particular
391		-	type of specialty provider review the case, a health care provider
392		-	who is of the same or a similar specialty as the health care
393		-	provider who would typically manage the medical or dental
394		-	condition, procedure, or treatment under consideration for review
395		-	shall review the denial or the decision denying the appeal. The
396		-	specialty review must be completed within 15 working days of the
397		-	date the health care provider's request for specialty review is
398		-	received.
399		-	SECTION 3.06. Section 4201.357(a), Insurance Code, is
400		-	amended to read as follows:
401		-	(a) The procedures for appealing an adverse determination
402		-	must include, in addition to the written appeal, a procedure for an
403		-	expedited appeal of a denial of emergency care, [or] a denial of
404		-	continued hospitalization, or a denial of another service if the
405		-	requesting health care provider includes a written statement with
406		-	supporting documentation that the service is necessary to treat a
407		-	life-threatening condition or prevent serious harm to the patient.
408		-	That procedure must include a review by a health care provider who:
409		-	(1) has not previously reviewed the case; and
410		-	(2) is of the same or a similar specialty as the health
411		-	care provider who would typically manage the medical or dental
412		-	condition, procedure, or treatment under review in the appeal.
413		-	SECTION 3.07. Sections 4201.453 and 4201.454, Insurance
414		-	Code, are amended to read as follows:
415		-	Sec. 4201.453. UTILIZATION REVIEW PLAN. A specialty
416		-	utilization review agent's utilization review plan, including
417		-	reconsideration and appeal requirements, must be:
418		-	(1) reviewed by a health care provider of the
419		-	appropriate specialty who is licensed or otherwise authorized to
420		-	provide the specialty health care service in this state; and
421		-	(2) conducted in accordance with standards developed
422		-	with input from a health care provider of the appropriate specialty
423		-	who is licensed or otherwise authorized to provide the specialty
424		-	health care service in this state.
425		-	Sec. 4201.454. UTILIZATION REVIEW UNDER DIRECTION OF
426		-	PROVIDER OF SAME SPECIALTY. A specialty utilization review agent
427		-	shall conduct utilization review under the direction of a health
428		-	care provider who is of the same specialty as the agent and who is
429		-	licensed or otherwise authorized to provide the specialty health
430		-	care service in this [by a] state [licensing agency in the United
431		-	States].
432		-	SECTION 3.08. Section 4201.455(a), Insurance Code, is
433		-	amended to read as follows:
434		-	(a) Personnel who are employed by or under contract with a
435		-	specialty utilization review agent to perform utilization review
436		-	must be appropriately trained and qualified and meet the
437		-	requirements of this chapter and other applicable law of this
438		-	state, including applicable licensing laws.
439		-	SECTION 3.09. Section 4201.456, Insurance Code, is amended
440		-	to read as follows:
441		-	Sec. 4201.456. OPPORTUNITY TO DISCUSS TREATMENT BEFORE
442		-	ADVERSE DETERMINATION. Subject to the notice requirements of
443		-	Subchapter G, before an adverse determination is issued by a
444		-	specialty utilization review agent who questions the medical
445		-	necessity, the [or] appropriateness, or the experimental or
446		-	investigational nature[,] of a health care service, the agent shall
447		-	provide the health care provider who ordered, requested, or is to
448		-	provide the service a reasonable opportunity to discuss the
449		-	patient's treatment plan and the clinical basis for the agent's
450		-	determination with a health care provider who is of the same
451		-	specialty as the agent.
452		-	SECTION 3.10. Section 408.0043, Labor Code, is amended by
453		-	adding Subsection (c) to read as follows:
454		-	(c) Notwithstanding Subsection (b), if a health care
455		-	service is requested, ordered, provided, or to be provided by a
456		-	physician, a person described by Subsection (a)(1), (2), or (3) who
457		-	reviews the service with respect to a specific workers'
458		-	compensation case must be of the same or a similar specialty as that
459		-	physician.
460		-	SECTION 3.11. Section 1305.351(d), Insurance Code, is
461		-	amended to read as follows:
462		-	(d) A [Notwithstanding Section 4201.152, a] utilization
463		-	review agent or an insurance carrier that uses doctors to perform
464		-	reviews of health care services provided under this chapter,
465		-	including utilization review, or peer reviews under Section
466		-	408.0231(g), Labor Code, may only use doctors licensed to practice
467		-	in this state.
468		-	SECTION 3.12. Section 1305.355(d), Insurance Code, is
469		-	amended to read as follows:
470		-	(d) The department shall assign the review request to an
471		-	independent review organization. An [Notwithstanding Section
472		-	4202.002, an] independent review organization that uses doctors to
473		-	perform reviews of health care services under this chapter may only
474		-	use doctors licensed to practice in this state.
475		-	SECTION 3.13. Section 408.023(h), Labor Code, is amended to
476		-	read as follows:
477		-	(h) A [Notwithstanding Section 4201.152, Insurance Code, a]
478		-	utilization review agent or an insurance carrier that uses doctors
479		-	to perform reviews of health care services provided under this
480		-	subtitle, including utilization review, may only use doctors
481		-	licensed to practice in this state.
482		-	SECTION 3.14. Section 413.031(e-2), Labor Code, is amended
483		-	to read as follows:
484		-	(e-2) An [Notwithstanding Section 4202.002, Insurance Code,
485		-	an] independent review organization that uses doctors to perform
486		-	reviews of health care services provided under this title may only
487		-	use doctors licensed to practice in this state.
488		-	ARTICLE 4. JOINT INTERIM STUDY
489		-	SECTION 4.01. CREATION OF JOINT INTERIM COMMITTEE. (a) A
490		-	joint interim committee is created to study, review, and report on
491		-	the use of prior authorization and utilization review processes by
492		-	private health benefit plan issuers in this state, as provided by
493		-	Section 4.02 of this article, and propose reforms under that
494		-	section related to the transparency of and improving patient
495		-	outcomes under the prior authorization and utilization review
496		-	processes used by private health benefit plan issuers in this
497		-	state.
498		-	(b) The joint interim committee shall be composed of four
499		-	senators appointed by the lieutenant governor and four members of
500		-	the house of representatives appointed by the speaker of the house
501		-	of representatives.
502		-	(c) The lieutenant governor and speaker of the house of
503		-	representatives shall each designate a co-chair from among the
504		-	joint interim committee members.
505		-	(d) The joint interim committee shall convene at the joint
506		-	call of the co-chairs.
507		-	(e) The joint interim committee has all other powers and
508		-	duties provided to a special or select committee by the rules of the
509		-	senate and house of representatives, by Subchapter B, Chapter 301,
510		-	Government Code, and by policies of the senate and house committees
511		-	on administration.
512		-	SECTION 4.02. INTERIM STUDY REGARDING PRIOR AUTHORIZATION
513		-	AND UTILIZATION REVIEW PROCESSES. (a) The joint interim committee
514		-	created by Section 4.01 of this article shall study data and other
515		-	information available from the Texas Department of Insurance, the
516		-	office of public insurance counsel, or other sources the committee
517		-	determines relevant to examine and analyze the transparency of and
518		-	improving patient outcomes under the prior authorization and
519		-	utilization review processes used by private health benefit plan
520		-	issuers in this state.
521		-	(b) The joint interim committee shall propose reforms based
522		-	on the study required under Subsection (a) of this section to
523		-	improve the transparency of and patient outcomes under prior
524		-	authorization and utilization review processes in this state.
525		-	(c) The joint interim committee shall prepare a report of
526		-	the findings and proposed reforms.
527		-	SECTION 4.03. COMMITTEE FINDINGS AND PROPOSED REFORMS.
528		-	(a) Not later than December 1, 2020, the joint interim committee
529		-	created under Section 4.01 of this article shall submit to the
530		-	lieutenant governor, the speaker of the house of representatives,
531		-	and the governor the report prepared under Section 4.02 of this
532		-	article. The joint interim committee shall include in its report
533		-	recommendations of specific statutory and regulatory changes that
534		-	appear necessary from the committee's study under Section 4.02 of
535		-	this article.
536		-	(b) Not later than the 60th day after the effective date of
537		-	this Act, the lieutenant governor and speaker of the house of
538		-	representatives shall appoint the members of the joint interim
539		-	committee in accordance with Section 4.01 of this article.
540		-	SECTION 4.04. ABOLITION OF COMMITTEE. The joint interim
541		-	committee created under Section 4.01 of this article is abolished
542		-	and this article expires December 15, 2020.
543		-	ARTICLE 5. TRANSITIONS; EFFECTIVE DATE
544		-	SECTION 5.01. A health benefit plan issuer shall update the
	78	+	SECTION 4. A health benefit plan issuer shall update the
545	79		issuer's website to conform with Subchapter K, Chapter 1451,
546		-	Insurance Code, as amended by Article 1 of this Act, not later than
547		-	January 1, 2020.
548		-	SECTION 5.02. The changes in law made by Article 2 of this
549		-	Act apply only to a request for preauthorization of medical care or
550		-	health care services made on or after January 1, 2020, under a
551		-	health benefit plan delivered, issued for delivery, or renewed on
552		-	or after that date. A request for preauthorization of medical care
553		-	or health care services made before January 1, 2020, or on or after
554		-	January 1, 2020, under a health benefit plan delivered, issued for
555		-	delivery, or renewed before that date is governed by the law as it
556		-	existed immediately before the effective date of this Act, and that
557		-	law is continued in effect for that purpose.
558		-	SECTION 5.03. The changes in law made by Article 3 of this
559		-	Act apply only to utilization, independent, or peer review
560		-	requested on or after the effective date of this Act. Utilization,
561		-	independent, or peer review requested before the effective date of
562		-	this Act is governed by the law as it existed immediately before the
563		-	effective date of this Act, and that law is continued in effect for
564		-	that purpose.
565		-	SECTION 5.04. This Act takes effect September 1, 2019.
566		-	______________________________ ______________________________
567		-	President of the Senate Speaker of the House
568		-	I hereby certify that S.B. No. 1742 passed the Senate on
569		-	April 26, 2019, by the following vote: Yeas 30, Nays 0;
570		-	May 20, 2019, Senate refused to concur in House amendments and
571		-	requested appointment of Conference Committee; May 22, 2019, House
572		-	granted request of the Senate; May 26, 2019, Senate adopted
573		-	Conference Committee Report by the following vote: Yeas 31,
574		-	Nays 0.
575		-	______________________________
576		-	Secretary of the Senate
577		-	I hereby certify that S.B. No. 1742 passed the House, with
578		-	amendments, on May 17, 2019, by the following vote: Yeas 117,
579		-	Nays 24, three present not voting; May 22, 2019, House granted
580		-	request of the Senate for appointment of Conference Committee;
581		-	May 26, 2019, House adopted Conference Committee Report by the
582		-	following vote: Yeas 104, Nays 37, two present not voting.
583		-	______________________________
584		-	Chief Clerk of the House
585		-	Approved:
586		-	______________________________
587		-	Date
588		-	______________________________
589		-	Governor
	80	+	Insurance Code, as amended by this Act, not later than January 1,
	81	+	2020.
	82	+	SECTION 5. This Act takes effect September 1, 2019.