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.