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Senate Bill 1216 |
Senate Author: Eltife |
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Effective: 9-1-13 |
House Sponsor: Davis, Sarah |
Senate Bill 1216 amends the Insurance Code to require the commissioner of insurance by rule to prescribe a single, standard form not later than January 1, 2015, for requesting prior authorization of health care services and, in prescribing the form, to take certain existing forms and standards into consideration. The bill also requires the commissioner by rule to require a health benefit plan issuer or the issuer's agent that manages or administers health care services benefits to use the form for any prior authorization required by the plan of health care services and to require that the Texas Department of Insurance and a health benefit plan issuer or the issuer's agent that manages or administers health care services benefits make the form available in paper form and electronically on their respective websites.
Senate Bill 1216 requires a health benefit plan issuer or the issuer's agent that manages or administers health care services benefits, not later than the second anniversary of the date national standards for electronic prior authorization of benefits are adopted, to exchange prior authorization requests electronically with a physician or health care provider who has electronic capability and who initiates a request electronically. For requests initiated on paper, the bill requires the health benefit plan issuer or the issuer's agent to accept prior authorization requests using the standard paper form developed by the commissioner.
Senate Bill 1216 requires the commissioner to appoint a committee to advise the commissioner on the technical, operational, and practical aspects of developing the single, standard prior authorization form. The bill sets out provisions relating to the composition and operation of the advisory committee. The bill specifies the types of health benefit plans and programs to which the bill's provisions apply and makes such provisions applicable only to a request for prior authorization of health care services made on or after September 1, 2015.