Texas 2023 - 88th Regular

Texas House Bill HB4367 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R22032 CJD-D
2	2	By: Cortez H.B. No. 4367
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the preauthorization of medical or health care services
8	8	by a health maintenance organization or an insurer.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 843.348, Insurance Code, is amended by
11	11	amending Subsection (g) and adding Subsection (g-1) to read as
12	12	follows:
13	13	(g) Unless a physician or provider has materially
14	14	misrepresented the proposed health care services or has
15	15	substantially failed to perform the proposed health care services,
16	16	if [If] the health maintenance organization has preauthorized
17	17	health care services, the health maintenance organization may not
18	18	deny or reduce payment to the physician or provider for those
19	19	services based on:
20	20	(1) medical necessity or appropriateness of care; or
21	21	(2) eligibility or coverage determinations if the
22	22	proposed health care service is provided to the enrollee before the
23	23	31st day after the date the health care service was preauthorized
24	24	and coverage is not terminated during that period [unless the
25	25	physician or provider has materially misrepresented the proposed
26	26	health care services or has substantially failed to perform the
27	27	proposed health care services].
28	28	(g-1) Notwithstanding Section 843.347 or any other law, and
29	29	for the purposes of Subsection (g), a health maintenance
30	30	organization may not require that the physician or provider request
31	31	verification.
32	32	SECTION 2. Section 1301.135, Insurance Code, is amended by
33	33	amending Subsection (f) and adding Subsection (f-1) to read as
34	34	follows:
35	35	(f) Unless a physician or health care provider has
36	36	materially misrepresented the proposed medical or health care
37	37	services or has substantially failed to perform the proposed
38	38	medical or health care services, if [If] an insurer has
39	39	preauthorized medical care or health care services, the insurer may
40	40	not deny or reduce payment to the physician or [health care]
41	41	provider for those services based on:
42	42	(1) medical necessity or appropriateness of care; or
43	43	(2) eligibility or coverage determinations if the
44	44	proposed medical or health care service is provided to the insured
45	45	before the 31st day after the date the medical or health care
46	46	service was preauthorized and coverage is not terminated during
47	47	that period [unless the physician or provider has materially
48	48	misrepresented the proposed medical or health care services or has
49	49	substantially failed to perform the proposed medical or health care
50	50	services].
51	51	(f-1) Notwithstanding Section 1301.133 or any other law,
52	52	and for the purposes of Subsection (f), an insurer may not require
53	53	that the physician or health care provider request verification.
54	54	SECTION 3. The changes in law made by this Act apply only to
55	55	a request for preauthorization of medical care or health care
56	56	services made on or after January 1, 2024, under a health benefit
57	57	plan delivered, issued for delivery, or renewed on or after that
58	58	date. A request for preauthorization of medical care or health care
59	59	services made before January 1, 2024, or on or after January 1,
60	60	2024, under a health benefit plan delivered, issued for delivery,
61	61	or renewed before that date, is governed by the law as it existed
62	62	immediately before the effective date of this Act, and that law is
63	63	continued in effect for that purpose.
64	64	SECTION 4. This Act takes effect September 1, 2023.