LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 88TH LEGISLATIVE REGULAR SESSION May 1, 2023 TO: Honorable Stephanie Klick, Chair, House Committee on Public Health FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB4343 by Bonnen (relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.), Committee Report 1st House, Substituted No significant fiscal implication to the State is anticipated. The bill would amend the Insurance Code to authorize the Texas Medical Board (TMB) to conduct investigations concerning utilization reviews that have been directed in an arbitrary manner or without medical basis. The bill would require TMB to notify the physician on the complaint, authorize the collection of information pertaining to the case, initiate enforcement proceedings if necessary, and authorize the board to temporarily suspend the licenses of physicians based on the results of the review. Under current law, the Department of Insurance is currently authorized to conduct these same investigations. Under the bill's provisions, TMB would have to suspend any inquiry if the Department of Insurance initiates a proceeding on the same case. Additionally, the bill would amend portions of the Insurance Code relating to the insurance provider's ability to request exemptions from preauthorization requirements for providing certain health services. Based on information provided by TMB, the Department of Insurance, and the State Office of Administrative Hearings, this estimate assumes that the number of cases related to this subject would be insignificant and the occurrence of these cases being escalated to a proceeding would be rare. This estimate assumes that duties and responsibilities associated with the increased workload could be accomplished by utilizing existing resources. Local Government ImpactNo significant fiscal implication to units of local government is anticipated. Source Agencies: b > td > 360 State Office of Administrative Hearings, 454 Department of Insurance, 503 Texas Medical Board LBB Staff: b > td > JMc, NPe, GDZ, BFa
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 88TH LEGISLATIVE REGULAR SESSION
May 1, 2023
TO: Honorable Stephanie Klick, Chair, House Committee on Public Health FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB4343 by Bonnen (relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.), Committee Report 1st House, Substituted
TO: Honorable Stephanie Klick, Chair, House Committee on Public Health
FROM: Jerry McGinty, Director, Legislative Budget Board
IN RE: HB4343 by Bonnen (relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.), Committee Report 1st House, Substituted
Honorable Stephanie Klick, Chair, House Committee on Public Health
Honorable Stephanie Klick, Chair, House Committee on Public Health
Jerry McGinty, Director, Legislative Budget Board
Jerry McGinty, Director, Legislative Budget Board
HB4343 by Bonnen (relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.), Committee Report 1st House, Substituted
HB4343 by Bonnen (relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.), Committee Report 1st House, Substituted
No significant fiscal implication to the State is anticipated.
No significant fiscal implication to the State is anticipated.
The bill would amend the Insurance Code to authorize the Texas Medical Board (TMB) to conduct investigations concerning utilization reviews that have been directed in an arbitrary manner or without medical basis. The bill would require TMB to notify the physician on the complaint, authorize the collection of information pertaining to the case, initiate enforcement proceedings if necessary, and authorize the board to temporarily suspend the licenses of physicians based on the results of the review. Under current law, the Department of Insurance is currently authorized to conduct these same investigations. Under the bill's provisions, TMB would have to suspend any inquiry if the Department of Insurance initiates a proceeding on the same case. Additionally, the bill would amend portions of the Insurance Code relating to the insurance provider's ability to request exemptions from preauthorization requirements for providing certain health services. Based on information provided by TMB, the Department of Insurance, and the State Office of Administrative Hearings, this estimate assumes that the number of cases related to this subject would be insignificant and the occurrence of these cases being escalated to a proceeding would be rare. This estimate assumes that duties and responsibilities associated with the increased workload could be accomplished by utilizing existing resources.
Based on information provided by TMB, the Department of Insurance, and the State Office of Administrative Hearings, this estimate assumes that the number of cases related to this subject would be insignificant and the occurrence of these cases being escalated to a proceeding would be rare. This estimate assumes that duties and responsibilities associated with the increased workload could be accomplished by utilizing existing resources.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies: b > td > 360 State Office of Administrative Hearings, 454 Department of Insurance, 503 Texas Medical Board
360 State Office of Administrative Hearings, 454 Department of Insurance, 503 Texas Medical Board
LBB Staff: b > td > JMc, NPe, GDZ, BFa
JMc, NPe, GDZ, BFa