Texas 2025 - 89th Regular

Texas Senate Bill SB547 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Menéndez, Alvarado S.B. No. 547
2		-	Hinojosa of Nueces
	1	+	By: Menéndez S.B. No. 547
	2	+	(In the Senate - Filed December 6, 2024; February 3, 2025,
	3	+	read first time and referred to Committee on Health & Human
	4	+	Services; April 28, 2025, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 9, Nays 0;
	6	+	April 28, 2025, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 547 By: Perry
3	9
4	10
5	11
6	12
7	13		A BILL TO BE ENTITLED
8	14		AN ACT
9	15		relating to notice from a health benefit plan issuer regarding a
10	16		physician's or health care provider's preauthorization exemption
11	17		status.
12	18		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	19		SECTION 1. Section 4201.659(e), Insurance Code, is amended
14	20		to read as follows:
15	21		(e) If a physician or provider submits a preauthorization
16	22		request for a health care service for which the physician or
17	23		provider qualifies for an exemption from preauthorization
18	24		requirements under Section 4201.653, the health maintenance
19	25		organization or insurer must promptly provide a notice to the
20	26		physician or provider that includes:
21	27		(1) a statement that the physician or provider
22	28		qualifies for an exemption from preauthorization requirements
23	29		under Section 4201.653;
24	30		(2) a list of the health care services and health
25	31		benefit plans to which the exemption applies;
26	32		(3) a statement of the duration of the exemption [the
27	33		information described by Subsection (d)]; and
28	34		(4) [(2)] a notification of the health maintenance
29	35		organization's or insurer's payment requirements.
30	36		SECTION 2. Subchapter N, Chapter 4201, Insurance Code, is
31	37		amended by adding Section 4201.660 to read as follows:
32	38		Sec. 4201.660. EXEMPTION STATUS NOTIFICATION TO
33	39		DEPARTMENT; DATABASE AND REPORT. (a) A health maintenance
34	40		organization or insurer that uses a preauthorization process for
35	41		health care services shall provide written notice to the department
36	42		of a physician's or provider's preauthorization exemption status
37	43		under this subchapter not later than the 10th day after the date on
38	44		which the health maintenance organization or insurer:
39	45		(1) completes an evaluation of the physician or
40	46		provider as required by Section 4201.653(b) and determines whether
41	47		the physician or provider qualifies for an exemption;
42	48		(2) determines that the health maintenance
43	49		organization or insurer will continue the physician's or provider's
44	50		exemption under Section 4201.653(c);
45	51		(3) provides notice to the physician or provider of a
46	52		determination to rescind the physician's or provider's exemption;
47	53		or
48	54		(4) makes an internal appeal determination or receives
49	55		a determination from an independent review organization under
50	56		Section 4201.656 affirming or denying the health maintenance
51	57		organization's or insurer's determination to rescind the
52	58		physician's or provider's exemption.
53	59		(b) The department shall establish and maintain a database
54	60		of preauthorization exemption grants, denials, recissions, and
55	61		internal appeal and independent review determinations. On the
56	62		request of a physician or provider, the department shall provide
57	63		the physician or provider with information regarding the
58	64		physician's or provider's preauthorization exemption status with
59	65		respect to each relevant health maintenance organization or insurer
60	66		and with respect to each relevant health care service.
61	67		(c) The department shall collect and compile data
62	68		regarding:
63	69		(1) the number and timing of evaluations being
64	70		conducted by each health maintenance organization or insurer under
65	71		this subchapter;
66	72		(2) the number of internal appeals or independent
67	73		reviews conducted by or with respect to each health maintenance
68	74		organization or insurer under this subchapter;
69	75		(3) the number of exemptions granted, denied, or
70	76		rescinded by each health maintenance organization or insurer, by
71	77		provider type and health care service; and
72	78		(4) the number and outcomes of internal appeals or
73	79		independent reviews conducted by or with respect to each health
74	80		maintenance organization or insurer.
75	81		(d) The department shall annually prepare a statistical
76	82		report reflecting the data collected under Subsection (c) and make
77	83		the report available to the public on request.
78	84		SECTION 3. Section 4201.659(d), Insurance Code, is
79	85		repealed.
80	86		SECTION 4. Subchapter N, Chapter 4201, Insurance Code, as
81	87		amended by this Act, applies only to a determination regarding a
82	88		physician's or provider's preauthorization exemption status made on
83	89		or after the effective date of this Act. A determination made
84	90		before the effective date of this Act is governed by the law as it
85	91		existed immediately before the effective date of this Act, and that
86	92		law is continued in effect for that purpose.
87	93		SECTION 5. This Act takes effect September 1, 2025.
	94	+	* * * * *