87R22415 E
By: Vo H.B. No. 2142
Substitute the following for H.B. No. 2142:
By: Oliverson C.S.H.B. No. 2142
A BILL TO BE ENTITLED
AN ACT
relating to preauthorization requirements and examinations of
certain health benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.154(f), Insurance Code, is amended
to read as follows:
(f) A health maintenance organization shall pay to the
commissioner a fee in an amount assessed by the commissioner and
paid in accordance with rules adopted by the commissioner for the
expenses of an examination under Section 843.156 [843.156(a)] that:
(1) are incurred by the commissioner or under the
commissioner's authority; and
(2) are directly attributable to that examination,
including the actual salaries and expenses of the examiners
directly attributable to that examination, as determined under
rules adopted by the commissioner.
SECTION 2. Section 843.156, Insurance Code, is amended by
adding Subsections (a-1) and (a-2) to read as follows:
(a-1) The commissioner shall examine a health maintenance
organization to determine the health maintenance organization's
compliance with applicable requirements of this code related to
utilization review, including requirements in this chapter,
Chapter 1222, Chapter 1369, and Chapter 4201 related to
preauthorization of health care services. Except as provided by
Subsection (a-2), a health maintenance organization is subject to
an examination by the commissioner under this subsection at least
once every year and whenever the commissioner considers an
examination necessary. Documentation provided to the commissioner
during an examination conducted under this subsection is
confidential and is not subject to disclosure as public information
under Chapter 552, Government Code. In this section, "utilization
review" has the meaning assigned by Section 4201.002.
(a-2) If the commissioner has examined or will examine a
health maintenance organization to determine the health
maintenance organization's compliance with applicable requirements
of this code related to utilization review in another examination
conducted by the commissioner during the same year, the health
maintenance organization is not subject to an examination under
Subsection (a-1) that year.
SECTION 3. Section 1301.0056, Insurance Code, is amended by
adding Subsections (a-1) and (a-2) to read as follows:
(a-1) The commissioner shall examine an insurer to
determine the insurer's compliance with applicable requirements of
this code related to utilization review, including requirements in
this chapter, Chapter 1222, Chapter 1369, and Chapter 4201 related
to preauthorization of medical care or health care services.
Except as provided by Subsection (a-2), an insurer is subject to an
examination by the commissioner under this subsection at least once
every year and whenever the commissioner considers an examination
necessary. In this section, "utilization review" has the meaning
assigned by Section 4201.002.
(a-2) If the commissioner has examined or will examine an
insurer to determine the insurer's compliance with applicable
requirements of this code related to utilization review in another
examination conducted by the commissioner during the same year, the
insurer is not subject to an examination under Subsection (a-1)
that year.
SECTION 4. This Act takes effect September 1, 2021.