TX
Texas House Bill HB2142

Texas 2021 - 87th Regular

Texas House Bill HB2142 Compare Versions

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1-87R22415 E
21 By: Vo H.B. No. 2142
3- Substitute the following for H.B. No. 2142:
4- By: Oliverson C.S.H.B. No. 2142
52
63
74 A BILL TO BE ENTITLED
85 AN ACT
96 relating to preauthorization requirements and examinations of
107 certain health benefit plan issuers.
118 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
129 SECTION 1. Section 843.154(f), Insurance Code, is amended
1310 to read as follows:
1411 (f) A health maintenance organization shall pay to the
1512 commissioner a fee in an amount assessed by the commissioner and
1613 paid in accordance with rules adopted by the commissioner for the
17- expenses of an examination under Section 843.156 [843.156(a)] that:
14+ expenses of an examination under Section 843.156[(a)] that:
1815 (1) are incurred by the commissioner or under the
1916 commissioner's authority; and
2017 (2) are directly attributable to that examination,
2118 including the actual salaries and expenses of the examiners
2219 directly attributable to that examination, as determined under
2320 rules adopted by the commissioner.
2421 SECTION 2. Section 843.156, Insurance Code, is amended by
25- adding Subsections (a-1) and (a-2) to read as follows:
22+ adding Subsection (a-1) to read as follows:
2623 (a-1) The commissioner shall examine a health maintenance
27- organization to determine the health maintenance organization's
24+ organization that uses a preauthorization process for health care
25+ services to determine the health maintenance organization's
2826 compliance with applicable requirements of this Code related to
29- utilization review, including requirements in this chapter,
30- Chapter 1222, Chapter 1369, and Chapter 4201 related to
31- preauthorization of health care services. Except as provided by
32- Subsection (a-2), a health maintenance organization is subject to
33- an examination by the commissioner under this subsection at least
34- once every year and whenever the commissioner considers an
35- examination necessary. Documentation provided to the commissioner
36- during an examination conducted under this subsection is
37- confidential and is not subject to disclosure as public information
38- under Chapter 552, Government Code. In this section, "utilization
39- review" has the meaning assigned by Section 4201.002.
40- (a-2) If the commissioner has examined or will examine a
41- health maintenance organization to determine the health
42- maintenance organization's compliance with applicable requirements
43- of this code related to utilization review in another examination
44- conducted by the commissioner during the same year, the health
45- maintenance organization is not subject to an examination under
46- Subsection (a-1) that year.
27+ preauthorization, including requirements in this chapter, Chapter
28+ 1222, Chapter 1369, and Chapter 4201. A health maintenance
29+ organization is subject to an examination by the commissioner under
30+ this subsection at least once every year and whenever the
31+ commissioner considers an examination necessary. Documentation
32+ provided to the commissioner during an examination conducted under
33+ this subsection is confidential and is not subject to disclosure as
34+ public information under Chapter 552, Government Code.
4735 SECTION 3. Section 1301.0056, Insurance Code, is amended by
48- adding Subsections (a-1) and (a-2) to read as follows:
49- (a-1) The commissioner shall examine an insurer to
50- determine the insurer's compliance with applicable requirements of
51- this code related to utilization review, including requirements in
52- this chapter, Chapter 1222, Chapter 1369, and Chapter 4201 related
53- to preauthorization of medical care or health care services.
54- Except as provided by Subsection (a-2), an insurer is subject to an
55- examination by the commissioner under this subsection at least once
56- every year and whenever the commissioner considers an examination
57- necessary. In this section, "utilization review" has the meaning
58- assigned by Section 4201.002.
59- (a-2) If the commissioner has examined or will examine an
60- insurer to determine the insurer's compliance with applicable
61- requirements of this code related to utilization review in another
62- examination conducted by the commissioner during the same year, the
63- insurer is not subject to an examination under Subsection (a-1)
64- that year.
36+ adding Subsection (a-1) to read as follows:
37+ (a-1) The commissioner shall examine an insurer that uses a
38+ preauthorization process for medical care or health care services
39+ to determine the insurer's compliance with applicable requirements
40+ of this Code related to preauthorization, including requirements in
41+ this chapter, Chapter 1222, Chapter 1369, and Chapter 4201. A
42+ insurer is subject to an examination by the commissioner under this
43+ subsection at least once every year and whenever the commissioner
44+ considers an examination necessary.
6545 SECTION 4. This Act takes effect September 1, 2021.