89R5925 DNC-F
By: Campbell S.B. No. 2012
A BILL TO BE ENTITLED
AN ACT
relating to the provision of certain information about physicians
and nurses making determinations regarding requests for
preauthorization of health care services or supplies.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter G, Chapter 4201, Insurance Code, is
amended by adding Section 4201.3025 to read as follows:
Sec. 4201.3025. PREAUTHORIZATION DETERMINATION: REQUIRED
PHYSICIAN INFORMATION. A utilization review agent shall include in
any written documentation that records a utilization review
determination made regarding a request for preauthorization, as
defined by Section 4201.651, or a determination made in an appeal of
an adverse determination made regarding a request for
preauthorization:
(1) the signature of the physician or nurse making the
determination;
(2) the full printed name of the physician or nurse;
(3) a unique provider identifier number for the
physician or nurse, such as a national provider identifier;
(4) the credentials of the physician or nurse,
including board certification and area of specialty expertise and
training, as applicable;
(5) attestation by the physician or nurse that the
physician or nurse has appropriate training and expertise in the
field of medicine that is sufficient to make an informed decision
regarding the medical necessity or appropriateness of the health
care service or supply proposed to be provided to the patient;
(6) attestation by the physician or nurse that the
physician or nurse does not have a conflict of interest that would
interfere with the physician's or nurse's ability to make an
impartial determination based on the merits of the specific patient
case; and
(7) the amount of time the physician or nurse spent
evaluating medical records or other information related to the
review or appeal before making the determination.
SECTION 2. Section 4201.3025, Insurance Code, as added by
this Act, applies only to a request for preauthorization made on or
after January 1, 2026, under a health benefit plan delivered,
issued for delivery, or renewed on or after that date.
SECTION 3. This Act takes effect September 1, 2025.