By: Johnson of Dallas H.B. No. 3542
A BILL TO BE ENTITLED
AN ACT
relating to the telephone availability of certain personnel by
certain health benefit plan issuers and utilization review agents.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 843.347(c), Insurance Code, is amended
to read as follows:
(c) A health maintenance organization shall have
appropriate personnel reasonably available at a toll-free
telephone number to provide a verification under this section 24
hours a day, every day of the year, including on Saturdays, Sundays,
and legal holidays [between 6 a.m. and 6 p.m. central time Monday
through Friday on each day that is not a legal holiday and between 9
a.m. and noon central time on Saturday, Sunday, and legal
holidays]. A health maintenance organization must have a telephone
system capable of accepting or recording incoming phone calls for
verifications during times when personnel are not available due to
circumstances beyond the health maintenance organization's
reasonable control [after 6 p.m. central time Monday through Friday
and after noon central time on Saturday, Sunday, and legal
holidays] and respond [responding] to each of those calls as soon as
possible and in no event later than two hours after the call [on or
before the second calendar day after the date the call] is received.
SECTION 2. Section 843.348(f), Insurance Code, is amended
to read as follows:
(f) A health maintenance organization shall have
appropriate personnel reasonably available at a toll-free
telephone number to respond to requests for a preauthorization 24
hours a day, every day of the year, including on Saturdays, Sundays,
and legal holidays [between 6 a.m. and 6 p.m. central time Monday
through Friday on each day that is not a legal holiday and between 9
a.m. and noon central time on Saturday, Sunday, and legal
holidays]. A health maintenance organization must have a telephone
system capable of accepting or recording incoming phone calls for
preauthorizations during times when personnel are not available due
to circumstances beyond the health maintenance organization's
reasonable control [after 6 p.m. central time Monday through Friday
and after noon central time on Saturday, Sunday, and legal
holidays] and respond [responding] to each of those calls as soon as
possible and in no event [not] later than two [24] hours after the
call is received.
SECTION 3. Section 1301.133(c), Insurance Code, is amended
to read as follows:
(c) An insurer shall have appropriate personnel reasonably
available at a toll-free telephone number to provide a verification
under this section 24 hours a day, every day of the year, including
on Saturdays, Sundays, and legal holidays [between 6 a.m. and 6 p.m.
central time Monday through Friday on each day that is not a legal
holiday and between 9 a.m. and noon central time on Saturday,
Sunday, and legal holidays]. An insurer must have a telephone
system capable of accepting or recording incoming phone calls for
verifications during times when personnel are not available due to
circumstances beyond the insurer's reasonable control [after 6 p.m.
central time Monday through Friday and after noon central time on
Saturday, Sunday, and legal holidays] and respond [responding] to
each of those calls as soon as possible and in no event later than
two hours after [on or before the second calendar day after the
date] the call is received.
SECTION 4. Section 1301.135(e), Insurance Code, is amended
to read as follows:
(e) An insurer shall have appropriate personnel reasonably
available at a toll-free telephone number to respond to requests
for a preauthorization 24 hours a day, every day of the year,
including on Saturdays, Sundays, and legal holidays [between 6 a.m.
and 6 p.m. central time Monday through Friday on each day that is
not a legal holiday and between 9 a.m. and noon central time on
Saturday, Sunday, and legal holidays]. An insurer must have a
telephone system capable of accepting or recording incoming phone
calls for preauthorizations during times when personnel are not
available due to circumstances beyond the insurer's reasonable
control [after 6 p.m. central time Monday through Friday and after
noon central time on Saturday, Sunday, and legal holidays] and
respond [responding] to each of those calls as soon as possible and
in no event [not] later than two [24] hours after the call is
received.
SECTION 5. Section 4201.004(a), Insurance Code is amended
to read as follows:
(a) A utilization review agent shall:
(1) have appropriate personnel reasonably available,
by toll-free telephone available 24 hours a day, every day of the
year, including on Saturdays, Sundays, and legal holidays[at least
40 hours per week during normal business hours in this state], to
discuss patients' care and allow response to telephone review
requests;
(2) have a telephone system capable, during times when
personnel are not available due to circumstances beyond the
utilization review agent's reasonable control[during hours other
than normal business hours], of accepting or recording incoming
telephone calls or of providing instructions to a caller; and
(3) respond to a call made during times when personnel
are unavailable due to circumstances described in subdivision (2)
as soon as possible and in no event [hours other than normal
business hours not] later than two hours [the second working day]
after the call was received[the later of:
(A) the date the call was received; or
(B) the date the details necessary to respond
have been received from the caller].
SECTION 6. This Act takes effect September 1, 2021.