Texas 2025 - 89th Regular

Texas House Bill HB3845 Compare Versions

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

Old	New	Differences
1	1	89R5926 SCR-D
2	2	By: Oliverson H.B. No. 3845
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the regulation of certain compensation, contracting,
10	10	employment, and performance criteria in connection with
11	11	utilization review of health benefits.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Section 4201.154(b), Insurance Code, is amended
14	14	to read as follows:
15	15	(b) Any information obtained or acquired under the
16	16	authority of this section, Section 4201.153, and this chapter is
17	17	confidential and privileged and is not subject to Chapter 552,
18	18	Government Code, or to subpoena except to the extent necessary for:
19	19	(1) the commissioner to enforce this chapter; or
20	20	(2) discovery in an action brought under Section
21	21	4201.254.
22	22	SECTION 2. Subchapter D, Chapter 4201, Insurance Code, is
23	23	amended by adding Section 4201.156 to read as follows:
24	24	Sec. 4201.156. PROHIBITED BASES FOR COMPENSATION,
25	25	CONTRACTING, OR RETENTION OF UTILIZATION REVIEW AGENT. A payor may
26	26	not permit or provide compensation or another thing of value to a
27	27	utilization review agent based on, or condition a contract for the
28	28	services of a utilization review agent or the retention of a
29	29	utilization review agent's services on, an amount or volume of
30	30	adverse determinations, reductions of or limitations on lengths of
31	31	stay, benefits, services, or charges, or a number or frequency of
32	32	telephone calls or other contacts with health care providers or
33	33	patients, that is inconsistent with this chapter.
34	34	SECTION 3. Section 4201.253, Insurance Code, is amended to
35	35	read as follows:
36	36	Sec. 4201.253. PROHIBITED BASES FOR EMPLOYMENT,
37	37	COMPENSATION, EVALUATIONS, OR PERFORMANCE STANDARDS. A
38	38	utilization review agent may not:
39	39	(1) permit or provide compensation or another thing of
40	40	value to an employee or agent of the utilization review agent based
41	41	on, condition employment of the agent's employees or agent
42	42	evaluations on, or set employee or agent performance standards
43	43	based on, an [based on the] amount or [of] volume of adverse
44	44	determinations, reductions of or limitations on lengths of stay,
45	45	benefits, services, or charges, or a [the] number or frequency of
46	46	telephone calls or other contacts with health care providers or
47	47	patients, that is [are] inconsistent with this chapter;
48	48	(2) induce or pressure an employee or agent of the
49	49	utilization review agent to make an adverse determination or reduce
50	50	or limit lengths of stays, benefits, services, or charges; or
51	51	(3) terminate, demote, retaliate against, or
52	52	otherwise penalize an employee or agent of the utilization review
53	53	agent for failing to make an adverse determination or reduce or
54	54	limit lengths of stays, benefits, services, or charges.
55	55	SECTION 4. Subchapter F, Chapter 4201, Insurance Code, is
56	56	amended by adding Section 4201.254 to read as follows:
57	57	Sec. 4201.254. RETALIATION PROHIBITED. (a) An employee or
58	58	agent may bring an action against a utilization review agent that
59	59	suspends or terminates the employee's employment or the agent's
60	60	contractual relationship with the utilization review agent or
61	61	otherwise disciplines or discriminates or retaliates against the
62	62	employee or agent for:
63	63	(1) reporting in good faith to the employee's or
64	64	agent's supervisor or the department a violation of this chapter;
65	65	or
66	66	(2) initiating or cooperating in any investigation or
67	67	proceeding of a governmental entity relating to a potential
68	68	violation of this chapter.
69	69	(b) A prevailing claimant in an action brought under this
70	70	section may recover:
71	71	(1) the greater of $1,000 or actual damages, including
72	72	damages for mental anguish even if an injury other than mental
73	73	anguish is not shown, and damages for lost wages if the claimant's
74	74	employment was suspended or terminated;
75	75	(2) exemplary damages; and
76	76	(3) court costs and reasonable attorney's fees
77	77	incurred in bringing the action.
78	78	(c) In addition to the amounts that may be recovered under
79	79	Subsection (b), a claimant whose employment is suspended or
80	80	terminated is entitled to appropriate injunctive relief,
81	81	including, if applicable:
82	82	(1) reinstatement in the claimant's former position;
83	83	and
84	84	(2) reinstatement of lost fringe benefits or seniority
85	85	rights.
86	86	(d) In an action brought under this section, there is a
87	87	rebuttable presumption that a claimant's employment or contractual
88	88	relationship was suspended or terminated for reporting a violation
89	89	of this chapter if the claimant is suspended or terminated before
90	90	the 60th day after the date on which the person made the report.
91	91	(e) A claimant may bring an action under this section in a
92	92	district court of the county in which:
93	93	(1) the claimant resides;
94	94	(2) the claimant was employed by the defendant; or
95	95	(3) the defendant conducts business.
96	96	SECTION 5. The changes in law made by this Act apply only to
97	97	an contract entered into on or after the effective date of this Act.
98	98	SECTION 6. This Act takes effect September 1, 2025.