Texas 2025 - 89th Regular

Texas House Bill HB1818 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R4361 SCF-F
2	2	By: Vo H.B. No. 1818
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to examinations of health maintenance organizations and
10	10	insurers by the commissioner of insurance regarding compliance with
11	11	certain utilization review and preauthorization requirements;
12	12	authorizing a fee.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Section 843.154(f), Insurance Code, is amended
15	15	to read as follows:
16	16	(f) A health maintenance organization shall pay to the
17	17	commissioner a fee in an amount assessed by the commissioner and
18	18	paid in accordance with rules adopted by the commissioner for the
19	19	expenses of an examination under Section 843.156(a) or (a-1) that:
20	20	(1) are incurred by the commissioner or under the
21	21	commissioner's authority; and
22	22	(2) are directly attributable to that examination,
23	23	including the actual salaries and expenses of the examiners
24	24	directly attributable to that examination, as determined under
25	25	rules adopted by the commissioner.
26	26	SECTION 2. Section 843.156, Insurance Code, is amended by
27	27	adding Subsections (a-1) and (a-2) to read as follows:
28	28	(a-1) The commissioner shall examine a health maintenance
29	29	organization to determine the health maintenance organization's
30	30	compliance with applicable requirements related to utilization
31	31	review, including requirements under this chapter, Chapter 1222,
32	32	Chapter 1369, and Chapter 4201 that relate to the preauthorization
33	33	of health care services. The commissioner may conduct an
34	34	examination under this subsection as often as the commissioner
35	35	considers necessary but shall conduct an examination at least once
36	36	annually. Documentation provided to the commissioner during an
37	37	examination conducted under this subsection is confidential and is
38	38	not subject to disclosure as public information under Chapter 552,
39	39	Government Code. In this subsection and Subsection (a-2),
40	40	"utilization review" has the meaning assigned by Section 4201.002.
41	41	(a-2) If in a certain year the commissioner examines or will
42	42	examine a health maintenance organization's compliance with
43	43	applicable requirements related to utilization review as part of an
44	44	examination other than the examination required by Subsection
45	45	(a-1), the commissioner is not required to examine the health
46	46	maintenance organization under Subsection (a-1) in that year.
47	47	SECTION 3. Section 1301.0056, Insurance Code, is amended by
48	48	adding Subsections (a-2) and (a-3) to read as follows:
49	49	(a-2) The commissioner shall examine an insurer to
50	50	determine the insurer's compliance with applicable requirements
51	51	related to utilization review, including requirements under this
52	52	chapter, Chapter 1222, Chapter 1369, and Chapter 4201 that relate
53	53	to the preauthorization of medical care or health care services.
54	54	The commissioner may conduct an examination under this subsection
55	55	as often as the commissioner considers necessary but shall conduct
56	56	an examination at least once annually. In this subsection and
57	57	Subsection (a-3), "utilization review" has the meaning assigned by
58	58	Section 4201.002.
59	59	(a-3) If in a certain year the commissioner examines or will
60	60	examine an insurer's compliance with applicable requirements
61	61	related to utilization review as part of an examination other than
62	62	the examination required by Subsection (a-2), the commissioner is
63	63	not required to examine the insurer under Subsection (a-2) in that
64	64	year.
65	65	SECTION 4. This Act takes effect September 1, 2025.