Texas 2023 - 88th Regular

Texas House Bill HB4067 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R9251 KBB-F
2	2	By: Vo H.B. No. 4067
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to examinations of health maintenance organizations and
8	8	insurers by the commissioner of insurance regarding compliance with
9	9	certain utilization review and preauthorization requirements;
10	10	authorizing a fee.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 843.154(f), Insurance Code, is amended
13	13	to read as follows:
14	14	(f) A health maintenance organization shall pay to the
15	15	commissioner a fee in an amount assessed by the commissioner and
16	16	paid in accordance with rules adopted by the commissioner for the
17	17	expenses of an examination under Section 843.156(a) or (a-1) that:
18	18	(1) are incurred by the commissioner or under the
19	19	commissioner's authority; and
20	20	(2) are directly attributable to that examination,
21	21	including the actual salaries and expenses of the examiners
22	22	directly attributable to that examination, as determined under
23	23	rules adopted by the commissioner.
24	24	SECTION 2. Section 843.156, Insurance Code, is amended by
25	25	adding Subsections (a-1) and (a-2) to read as follows:
26	26	(a-1) The commissioner shall examine a health maintenance
27	27	organization to determine the health maintenance organization's
28	28	compliance with applicable requirements related to utilization
29	29	review, including requirements under this chapter, Chapter 1222,
30	30	Chapter 1369, and Chapter 4201 that relate to the preauthorization
31	31	of health care services. The commissioner may conduct an
32	32	examination under this subsection as often as the commissioner
33	33	considers necessary but shall conduct an examination at least once
34	34	annually. Documentation provided to the commissioner during an
35	35	examination conducted under this subsection is confidential and is
36	36	not subject to disclosure as public information under Chapter 552,
37	37	Government Code. In this subsection and Subsection (a-2),
38	38	"utilization review" has the meaning assigned by Section 4201.002.
39	39	(a-2) If in a certain year the commissioner examines or will
40	40	examine a health maintenance organization's compliance with
41	41	applicable requirements related to utilization review as part of an
42	42	examination other than the examination required by Subsection
43	43	(a-1), the commissioner is not required to examine the health
44	44	maintenance organization under Subsection (a-1) in that year.
45	45	SECTION 3. Section 1301.0056, Insurance Code, is amended by
46	46	adding Subsections (a-1) and (a-2) to read as follows:
47	47	(a-1) The commissioner shall examine an insurer to
48	48	determine the insurer's compliance with applicable requirements
49	49	related to utilization review, including requirements under this
50	50	chapter, Chapter 1222, Chapter 1369, and Chapter 4201 that relate
51	51	to the preauthorization of medical care or health care services.
52	52	The commissioner may conduct an examination under this subsection
53	53	as often as the commissioner considers necessary but shall conduct
54	54	an examination at least once annually. In this subsection and
55	55	Subsection (a-2), "utilization review" has the meaning assigned by
56	56	Section 4201.002.
57	57	(a-2) If in a certain year the commissioner examines or will
58	58	examine an insurer's compliance with applicable requirements
59	59	related to utilization review as part of an examination other than
60	60	the examination required by Subsection (a-1), the commissioner is
61	61	not required to examine the insurer under Subsection (a-1) in that
62	62	year.
63	63	SECTION 4. This Act takes effect September 1, 2023.