89R2727 RDS-F
By: Menéndez S.B. No. 177
A BILL TO BE ENTITLED
AN ACT
relating to telephone access for certain health benefit plan
verifications and preauthorization requests and for utilization
review requests.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.347(c), Insurance Code, is amended
to read as follows:
(c) A health maintenance organization shall have
appropriate personnel reasonably available at a toll-free
telephone number to provide a verification under this section 24
hours a day, seven days a week, including [between 6 a.m. and 6 p.m.
central time Monday through Friday on each day that is not a legal
holiday and between 9 a.m. and noon central time on Saturday,
Sunday, and] legal holidays. A health maintenance organization
must:
(1) have a telephone system capable of accepting or
recording incoming phone calls for verifications during any period
in which personnel are not available due to circumstances beyond
the health maintenance organization's reasonable control; [after 6
p.m. central time Monday through Friday and after noon central time
on Saturday, Sunday, and legal holidays] and
(2) respond [responding] to each of those calls as
soon as possible but not later than two hours after [on or before
the second calendar day after the date] the call is received.
SECTION 2. Section 843.348(f), Insurance Code, is amended
to read as follows:
(f) A health maintenance organization shall have
appropriate personnel reasonably available at a toll-free
telephone number to respond to requests for a preauthorization 24
hours a day, seven days a week, including [between 6 a.m. and 6 p.m.
central time Monday through Friday on each day that is not a legal
holiday and between 9 a.m. and noon central time on Saturday,
Sunday, and] legal holidays. A health maintenance organization
must:
(1) have a telephone system capable of accepting or
recording incoming phone calls for preauthorizations during any
period in which personnel are not available due to circumstances
beyond the health maintenance organization's reasonable control;
[after 6 p.m. central time Monday through Friday and after noon
central time on Saturday, Sunday, and legal holidays] and
(2) respond [responding] to each of those calls as
soon as possible but not later than two [24] hours after the call is
received.
SECTION 3. Section 1301.133(c), Insurance Code, is amended
to read as follows:
(c) An insurer shall have appropriate personnel reasonably
available at a toll-free telephone number to provide a verification
under this section 24 hours a day, seven days a week, including
[between 6 a.m. and 6 p.m. central time Monday through Friday on
each day that is not a legal holiday and between 9 a.m. and noon
central time on Saturday, Sunday, and] legal holidays. An insurer
must:
(1) have a telephone system capable of accepting or
recording incoming phone calls for verifications during any period
in which personnel are not available due to circumstances beyond
the insurer's reasonable control; [after 6 p.m. central time Monday
through Friday and after noon central time on Saturday, Sunday, and
legal holidays] and
(2) respond [responding] to each of those calls as
soon as possible but not later than two hours after [on or before
the second calendar day after the date] the call is received.
SECTION 4. Section 1301.135(e), Insurance Code, is amended
to read as follows:
(e) An insurer shall have appropriate personnel reasonably
available at a toll-free telephone number to respond to requests
for a preauthorization 24 hours a day, seven days a week, including
[between 6 a.m. and 6 p.m. central time Monday through Friday on
each day that is not a legal holiday and between 9 a.m. and noon
central time on Saturday, Sunday, and] legal holidays. An insurer
must:
(1) have a telephone system capable of accepting or
recording incoming phone calls for preauthorizations during any
period in which personnel are not available due to circumstances
beyond the insurer's reasonable control; [after 6 p.m. central time
Monday through Friday and after noon central time on Saturday,
Sunday, and legal holidays] and
(2) respond [responding] to each of those calls as
soon as possible but not later than two [24] hours after the call is
received.
SECTION 5. Section 4201.004(a), Insurance Code, is amended
to read as follows:
(a) A utilization review agent shall:
(1) have appropriate personnel reasonably available,
by toll-free telephone 24 hours a day, seven days a week, including
legal holidays [at least 40 hours per week during normal business
hours in this state], to discuss patients' care and allow response
to telephone review requests;
(2) have a telephone system capable, during any period
in which personnel are not available due to circumstances beyond
the utilization review agent's reasonable control [hours other than
normal business hours], of accepting or recording incoming
telephone calls or of providing instructions to a caller; and
(3) respond to a call made during a period described by
Subdivision (2) as soon as possible but [hours other than normal
business hours] not later than two hours [the second working day]
after the call is received [later of:
[(A) the date the call was received; or
[(B) the date the details necessary to respond
have been received from the caller].
SECTION 6. This Act takes effect September 1, 2025.