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A BILL TO BE ENTITLED
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AN ACT
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relating to preauthorization of certain benefits by certain health |
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benefit plan issuers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1356.005, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A health benefit plan issuer that provides coverage |
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under this section may not require preauthorization for a screening |
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mammogram or diagnostic imaging described by Subsection (a) or |
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(a-1). This subsection may not be construed to authorize a |
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physician or other health care provider to provide the medical care |
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or health care described by this section if providing the care is |
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outside of the scope of the individual's applicable license or |
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other authorization issued under Title 3, Occupations Code. |
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SECTION 2. Section 1357.004, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A health benefit plan issuer that provides coverage |
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under this section may not require preauthorization for a |
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reconstruction, surgery, prostheses, or treatment described by |
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Subsection (a). This subsection may not be construed to authorize a |
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physician or other health care provider to provide the medical care |
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or health care described by this section if providing the care is |
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outside of the scope of the individual's applicable license or |
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other authorization issued under Title 3, Occupations Code. |
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SECTION 3. Section 1357.054, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A health benefit plan issuer that provides coverage |
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under this section may not require preauthorization for inpatient |
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care described by Subsection (a). This subsection may not be |
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construed to authorize a physician or other health care provider to |
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provide the medical care or health care described by this section if |
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providing the care is outside of the scope of the individual's |
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applicable license or other authorization issued under Title 3, |
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Occupations Code. |
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SECTION 4. Section 1358.054, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A health benefit plan issuer that provides coverage |
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under this section may not require preauthorization for the |
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provision to a qualified enrollee of diabetes equipment, diabetes |
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supplies, or diabetes self-management training described by |
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Subsection (a). This subsection may not be construed to authorize a |
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physician or other health care provider to provide the medical care |
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or health care described by this section if providing the care is |
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outside of the scope of the individual's applicable license or |
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other authorization issued under Title 3, Occupations Code. |
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SECTION 5. Section 1361.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1361.003. COVERAGE REQUIRED. (a) A group health |
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benefit plan must provide to a qualified enrollee coverage for |
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medically accepted bone mass measurement to detect low bone mass |
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and to determine the enrollee's risk of osteoporosis and fractures |
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associated with osteoporosis. |
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(b) A group health benefit plan issuer that provides |
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coverage under this section may not require preauthorization for |
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the provision to a qualified enrollee of a bone mass measurement |
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described by Subsection (a). This subsection may not be construed |
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to authorize a physician or other health care provider to provide |
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the medical care or health care described by this section if |
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providing the care is outside of the scope of the individual's |
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applicable license or other authorization issued under Title 3, |
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Occupations Code. |
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SECTION 6. Section 1362.003, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A health benefit plan issuer that provides coverage |
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under this section to an enrolled male may not require |
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preauthorization for a diagnostic examination described by |
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Subsection (a). This subsection may not be construed to authorize a |
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physician or other health care provider to provide the medical care |
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or health care described by this section if providing the care is |
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outside of the scope of the individual's applicable license or |
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other authorization issued under Title 3, Occupations Code. |
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SECTION 7. Section 1363.003, Insurance Code, is amended by |
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adding Subsection (d) to read as follows: |
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(d) A health benefit plan issuer that provides coverage |
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under this section may not require preauthorization for a screening |
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examination described by Subsection (a). This subsection may not |
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be construed to authorize a physician or other health care provider |
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to provide the medical care or health care described by this section |
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if providing the care is outside of the scope of the individual's |
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applicable license or other authorization issued under Title 3, |
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Occupations Code. |
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SECTION 8. This Act applies only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2024. |
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SECTION 9. This Act takes effect September 1, 2023. |