Texas 2023 - 88th Regular

Texas House Bill HB4326 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R4688 BEE/SCL-D
2	2	By: Bonnen H.B. No. 4326
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the direction of utilization review by physicians.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 4201.152, Insurance Code, is amended to
10	10	read as follows:
11	11	Sec. 4201.152. UTILIZATION REVIEW UNDER DIRECTION OF
12	12	PHYSICIAN. A utilization review agent shall conduct utilization
13	13	review under the direction of a physician licensed to practice
14	14	medicine in this state. The physician may not hold a license to
15	15	practice administrative medicine under Section 155.009,
16	16	Occupations Code.
17	17	SECTION 2. Subchapter M, Chapter 4201, Insurance Code, is
18	18	amended by adding Section 4201.6015 to read as follows:
19	19	Sec. 4201.6015. INQUIRY BY TEXAS MEDICAL BOARD. (a) If the
20	20	Texas Medical Board believes that a physician has directed a
21	21	utilization review in an arbitrary manner or without a medical
22	22	basis or receives a complaint with that allegation, the Texas
23	23	Medical Board:
24	24	(1) shall notify the physician of the allegation; and
25	25	(2) may compel the production of documents or other
26	26	information as necessary to determine whether the utilization
27	27	review was directed in an arbitrary manner or without a medical
28	28	basis.
29	29	(b) An inquiry and determination under this section is
30	30	limited to whether the utilization review was directed in an
31	31	arbitrary manner or without a medical basis in accordance with the
32	32	standards of medical practice. If the commissioner initiates a
33	33	proceeding under Section 4201.601 in relation to the same
34	34	utilization review for which the inquiry is being conducted, the
35	35	Texas Medical Board shall suspend the inquiry until the conclusion
36	36	of the commissioner's proceeding.
37	37	SECTION 3. The heading to Section 4201.602, Insurance Code,
38	38	is amended to read as follows:
39	39	Sec. 4201.602. ENFORCEMENT PROCEEDINGS [PROCEEDING].
40	40	SECTION 4. Section 4201.602(a), Insurance Code, is amended
41	41	to read as follows:
42	42	(a) The commissioner may initiate a proceeding under
43	43	Section 4201.601 [this subchapter]. The Texas Medical Board may
44	44	initiate a proceeding under Section 4201.6015.
45	45	SECTION 5. Section 4201.603, Insurance Code, is amended to
46	46	read as follows:
47	47	Sec. 4201.603. REMEDIES AND PENALTIES; EMERGENCY REMEDIES
48	48	[FOR VIOLATION]. (a) If the commissioner determines that a
49	49	utilization review agent, health maintenance organization,
50	50	insurer, or other person or entity conducting utilization review
51	51	has violated or is violating this chapter, the commissioner may:
52	52	(1) impose a sanction under Chapter 82;
53	53	(2) issue a cease and desist order under Chapter 83; or
54	54	(3) assess an administrative penalty under Chapter 84.
55	55	(b) The Texas Medical Board may restrict, suspend, or revoke
56	56	the license of a physician the board determines has directed a
57	57	utilization review in an arbitrary manner or without a medical
58	58	basis at the conclusion of a proceeding conducted under Section
59	59	4201.6015.
60	60	(c) If a utilization review results in the serious injury or
61	61	death of the individual who is the subject of the review, the
62	62	commissioner may temporarily prohibit a physician who directed the
63	63	review from directing utilization review and the Texas Medical
64	64	Board may temporarily suspend the physician's license. The
65	65	commissioner or Texas Medical Board, as applicable, shall conduct a
66	66	proceeding under Section 4201.601 or 4201.6015, as applicable,
67	67	regarding the utilization review, and the prohibition or suspension
68	68	is effective until the conclusion of the proceeding.
69	69	SECTION 6. Section 151.002(a)(13), Occupations Code, is
70	70	amended to read as follows:
71	71	(13) "Practicing medicine" means:
72	72	(A) the diagnosis, treatment, or offer to treat a
73	73	mental or physical disease or disorder or a physical deformity or
74	74	injury by any system or method, or the attempt to effect cures of
75	75	those conditions, by a person who:
76	76	(i) [(A)] publicly professes to be a
77	77	physician or surgeon; or
78	78	(ii) [(B)] directly or indirectly charges
79	79	money or other compensation for those services; and
80	80	(B) the direction of utilization review
81	81	conducted by a utilization review agent under Section 4201.152,
82	82	Insurance Code.
83	83	SECTION 7. The change in law made by this Act applies only
84	84	to utilization review conducted on or after the effective date of
85	85	this Act. Utilization review conducted before the effective date of
86	86	this Act is governed by the law as it existed immediately before the
87	87	effective date of this Act, and that law is continued in effect for
88	88	that purpose.
89	89	SECTION 8. This Act takes effect September 1, 2023.