89R6189 SCF-D
By: Bhojani H.B. No. 3127
A BILL TO BE ENTITLED
AN ACT
relating to the time for providing a response to a request for
preauthorization of health benefits.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 540.0303(b), Government Code, as
effective April 1, 2025, is amended to read as follows:
(b) In addition to the requirements of Subchapter F, a
contract between a Medicaid managed care organization and the
commission to which that subchapter applies must require that the
organization review and issue a determination on a prior
authorization request to which this section applies according to
the following time frames:
(1) within three calendar [business] days after the
organization receives the request; or
(2) within the time frame and following the process
the commission establishes if the organization receives a prior
authorization request that does not include sufficient or adequate
documentation.
SECTION 2. Section 1305.353(d), Insurance Code, is amended
to read as follows:
(d) For services not described under Subsection (e) or (f),
the determination under Subsection (c) must be issued and
transmitted not later than the third calendar [working] day after
the date the request is received. [For the purposes of this
subsection, "working day" has the meaning assigned by Section
4201.002.]
SECTION 3. Subchapter G, Chapter 4201, Insurance Code, is
amended by adding Section 4201.3045 to read as follows:
Sec. 4201.3045. TIME FOR NOTICE REGARDING PREAUTHORIZATION
REQUEST. (a) In this section, "preauthorization" means a
determination that health care services proposed to be provided to
a patient are medically necessary and appropriate.
(b) A utilization review agent must transmit notice of a
determination made in a utilization review of a preauthorization
request not later than the earlier of:
(1) the time by which the notice must be provided under
another provision of this subchapter or other applicable law; or
(2) the third calendar day after the date of the
preauthorization request.
SECTION 4. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. (a) Section 540.0303(b), Government Code, as
amended by this Act, applies only to a preauthorization request
under a contract entered into on or after the effective date of this
Act. A preauthorization request under a contract entered into
before the effective date of this Act is governed by the law as it
existed immediately before the effective date of this Act, and that
law is continued in effect for that purpose.
(b) Section 1305.353(d), Insurance Code, as amended by this
Act, applies only to a preauthorization request under a workers'
compensation health care network contract entered into or renewed
on or after the effective date of this Act. A preauthorization
request under a workers' compensation health care network contract
entered into or renewed before the effective date of this Act is
governed by the law as it existed immediately before the effective
date of this Act, and that law is continued in effect for that
purpose.
(c) Section 4201.3045, Insurance Code, as added by this Act,
applies only to a preauthorization request under a health insurance
policy or health benefit plan delivered, issued for delivery, or
renewed on or after January 1, 2026, or for which the plan year
commences on or after January 1, 2026. A preauthorization request
under a health insurance policy or health benefit plan delivered,
issued for delivery, or renewed before January 1, 2026, or for which
the plan year commenced before January 1, 2026, is governed by the
law as it existed immediately before the effective date of this Act,
and that law is continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2025.