Texas 2025 - 89th Regular

Texas House Bill HB3127 Compare Versions

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

Old	New	Differences
1	1	89R6189 SCF-D
2	2	By: Bhojani H.B. No. 3127
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the time for providing a response to a request for
10	10	preauthorization of health benefits.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 540.0303(b), Government Code, as
13	13	effective April 1, 2025, is amended to read as follows:
14	14	(b) In addition to the requirements of Subchapter F, a
15	15	contract between a Medicaid managed care organization and the
16	16	commission to which that subchapter applies must require that the
17	17	organization review and issue a determination on a prior
18	18	authorization request to which this section applies according to
19	19	the following time frames:
20	20	(1) within three calendar [business] days after the
21	21	organization receives the request; or
22	22	(2) within the time frame and following the process
23	23	the commission establishes if the organization receives a prior
24	24	authorization request that does not include sufficient or adequate
25	25	documentation.
26	26	SECTION 2. Section 1305.353(d), Insurance Code, is amended
27	27	to read as follows:
28	28	(d) For services not described under Subsection (e) or (f),
29	29	the determination under Subsection (c) must be issued and
30	30	transmitted not later than the third calendar [working] day after
31	31	the date the request is received. [For the purposes of this
32	32	subsection, "working day" has the meaning assigned by Section
33	33	4201.002.]
34	34	SECTION 3. Subchapter G, Chapter 4201, Insurance Code, is
35	35	amended by adding Section 4201.3045 to read as follows:
36	36	Sec. 4201.3045. TIME FOR NOTICE REGARDING PREAUTHORIZATION
37	37	REQUEST. (a) In this section, "preauthorization" means a
38	38	determination that health care services proposed to be provided to
39	39	a patient are medically necessary and appropriate.
40	40	(b) A utilization review agent must transmit notice of a
41	41	determination made in a utilization review of a preauthorization
42	42	request not later than the earlier of:
43	43	(1) the time by which the notice must be provided under
44	44	another provision of this subchapter or other applicable law; or
45	45	(2) the third calendar day after the date of the
46	46	preauthorization request.
47	47	SECTION 4. If before implementing any provision of this Act
48	48	a state agency determines that a waiver or authorization from a
49	49	federal agency is necessary for implementation of that provision,
50	50	the agency affected by the provision shall request the waiver or
51	51	authorization and may delay implementing that provision until the
52	52	waiver or authorization is granted.
53	53	SECTION 5. (a) Section 540.0303(b), Government Code, as
54	54	amended by this Act, applies only to a preauthorization request
55	55	under a contract entered into on or after the effective date of this
56	56	Act. A preauthorization request under a contract entered into
57	57	before the effective date of this Act is governed by the law as it
58	58	existed immediately before the effective date of this Act, and that
59	59	law is continued in effect for that purpose.
60	60	(b) Section 1305.353(d), Insurance Code, as amended by this
61	61	Act, applies only to a preauthorization request under a workers'
62	62	compensation health care network contract entered into or renewed
63	63	on or after the effective date of this Act. A preauthorization
64	64	request under a workers' compensation health care network contract
65	65	entered into or renewed before the effective date of this Act is
66	66	governed by the law as it existed immediately before the effective
67	67	date of this Act, and that law is continued in effect for that
68	68	purpose.
69	69	(c) Section 4201.3045, Insurance Code, as added by this Act,
70	70	applies only to a preauthorization request under a health insurance
71	71	policy or health benefit plan delivered, issued for delivery, or
72	72	renewed on or after January 1, 2026, or for which the plan year
73	73	commences on or after January 1, 2026. A preauthorization request
74	74	under a health insurance policy or health benefit plan delivered,
75	75	issued for delivery, or renewed before January 1, 2026, or for which
76	76	the plan year commenced before January 1, 2026, is governed by the
77	77	law as it existed immediately before the effective date of this Act,
78	78	and that law is continued in effect for that purpose.
79	79	SECTION 6. This Act takes effect September 1, 2025.