Texas House Bill HB4037

Texas 2025 - 89th Regular

• Filed: 3/7/25

Caption

Relating to anesthesia coverage and patient assessment requirements for certain health benefit plans.

Impact

The bill also introduces amendments to existing sections within the Insurance Code, requiring health plans to incorporate evaluations of patient physical status and the complexity of care determined by their treating physicians in calculations of necessity and benefit payment amounts. These changes are designed to promote a more individualized approach to patient care, taking into account diverse medical needs that may arise during treatment.

Summary

House Bill 4037 pertains to the coverage of anesthesia services and the requirements for patient assessments within certain health benefit plans. A significant aspect of the bill is the mandate that any health benefit plan providing coverage for medically necessary anesthesia must cover the entire duration of the anesthesia services performed. This provision aims to ensure that patients are adequately and continuously monitored throughout procedures requiring anesthesia, preventing gaps in care and potential complications.

Contention

Among the notable points of contention surrounding HB 4037 is the balance between expanding patient protections and the implications for health insurers and providers. Supporters argue that the additional requirements for coverage will enhance patient safety by ensuring thorough assessment and supervision during anesthesia-related procedures. Critics, however, may express concerns about potential increases in insurance costs and the administrative burdens on healthcare providers to comply with the enhanced assessment protocols.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 1551. Texas Employees Group Benefits Act
  • Section: New Section

• Chapter 1575. Texas Public School Employees Group Benefits Program
  • Section: 164
  • Section: New Section

• Chapter 1579. Texas School Employees Uniform Group Health Coverage
  • Section: 107
  • Section: New Section