HBA-TBM H.B. 1058 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1058
By: Chavez
Insurance
2/19/2001
Introduced



BACKGROUND AND PURPOSE 

Under current law regarding a health insurance company's review of the
medical necessity and appropriateness of heath care services, a utilization
review agent must be supervised by a licensed physician, but not
necessarily a physician licensed to practice medicine in Texas.  In
requesting that a speciality provider review a case, a health care provider
must set forth good cause in writing.  The amount of documentation
insurance companies require can slow down the appeals process.  House Bill
1058 requires a utilization review agent to be supervised by a physician
who is licensed in Texas and allows a health care provider to orally
provide good cause for having a specialty provider review the case. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

ANALYSIS

House Bill 1058 amends the Insurance Code to modify the provisions relating
to the review by a health maintenance organization or other health
insurance company of the medical necessity and appropriateness of health
care services being provided to an individual (utilization review).  The
bill requires a utilization review agent to be under the direction of a
physician licensed to practice medicine in this state, rather than by a
state licensing agency in the United States.  The bill adds that a health
care provider may request orally that a specialty provider review a case as
well as in writing. 

EFFECTIVE DATE

On passage, or if the Act does not receive the necessary vote, the Act
takes effect September 1, 2001.