89R419 CJD-F
By: Miles S.B. No. 1142
A BILL TO BE ENTITLED
AN ACT
relating to preauthorization of certain benefits by certain health
benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1356.005, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) A health benefit plan issuer that provides coverage
under this section may not require preauthorization for a screening
mammogram or diagnostic imaging described by Subsection (a) or
(a-1). This subsection may not be construed to authorize a
physician or other health care provider to provide the medical care
or health care described by this section if providing the care is
outside of the scope of the individual's applicable license or
other authorization issued under Title 3, Occupations Code.
SECTION 2. Section 1357.004, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) A health benefit plan issuer that provides coverage
under this section may not require preauthorization for a
reconstruction, surgery, prostheses, or treatment described by
Subsection (a). This subsection may not be construed to authorize a
physician or other health care provider to provide the medical care
or health care described by this section if providing the care is
outside of the scope of the individual's applicable license or
other authorization issued under Title 3, Occupations Code.
SECTION 3. Section 1357.054, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) A health benefit plan issuer that provides coverage
under this section may not require preauthorization for inpatient
care described by Subsection (a). This subsection may not be
construed to authorize a physician or other health care provider to
provide the medical care or health care described by this section if
providing the care is outside of the scope of the individual's
applicable license or other authorization issued under Title 3,
Occupations Code.
SECTION 4. Section 1358.054, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) A health benefit plan issuer that provides coverage
under this section may not require preauthorization for the
provision to a qualified enrollee of diabetes equipment, diabetes
supplies, or diabetes self-management training described by
Subsection (a). This subsection may not be construed to authorize a
physician or other health care provider to provide the medical care
or health care described by this section if providing the care is
outside of the scope of the individual's applicable license or
other authorization issued under Title 3, Occupations Code.
SECTION 5. Section 1361.003, Insurance Code, is amended to
read as follows:
Sec. 1361.003. COVERAGE REQUIRED. (a) A group health
benefit plan must provide to a qualified enrollee coverage for
medically accepted bone mass measurement to detect low bone mass
and to determine the enrollee's risk of osteoporosis and fractures
associated with osteoporosis.
(b) A group health benefit plan issuer that provides
coverage under this section may not require preauthorization for
the provision to a qualified enrollee of a bone mass measurement
described by Subsection (a). This subsection may not be construed
to authorize a physician or other health care provider to provide
the medical care or health care described by this section if
providing the care is outside of the scope of the individual's
applicable license or other authorization issued under Title 3,
Occupations Code.
SECTION 6. Section 1362.003, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) A health benefit plan issuer that provides coverage
under this section to an enrolled male may not require
preauthorization for a diagnostic examination described by
Subsection (a). This subsection may not be construed to authorize a
physician or other health care provider to provide the medical care
or health care described by this section if providing the care is
outside of the scope of the individual's applicable license or
other authorization issued under Title 3, Occupations Code.
SECTION 7. Section 1363.003, Insurance Code, is amended by
adding Subsection (d) to read as follows:
(d) A health benefit plan issuer that provides coverage
under this section may not require preauthorization for a screening
examination described by Subsection (a). This subsection may not
be construed to authorize a physician or other health care provider
to provide the medical care or health care described by this section
if providing the care is outside of the scope of the individual's
applicable license or other authorization issued under Title 3,
Occupations Code.
SECTION 8. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2026.
SECTION 9. This Act takes effect September 1, 2025.