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A BILL TO BE ENTITLED
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AN ACT
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relating to denial of payment for preauthorized health care |
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services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 1217, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1217. [STANDARD REQUEST FORM FOR] PRIOR AUTHORIZATION OF |
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HEALTH CARE SERVICES |
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SECTION 2. Chapter 1217, Insurance Code, is amended by |
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adding Section 1217.008 to read as follows: |
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Sec. 1217.008. PROHIBITION OF DENIAL OF PAYMENT FOR |
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PREAUTHORIZED HEALTH CARE SERVICES. If a health benefit plan |
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issuer has given prior authorization for health care services to be |
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performed by a physician or health care provider, the health |
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benefit plan issuer may not deny or reduce payment to the physician |
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or health care provider for those services based on medical |
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necessity or appropriateness of care unless the physician or |
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provider materially misrepresented the proposed health care |
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services or substantially failed to perform the proposed health |
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care services. |
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SECTION 3. This Act takes effect September 1, 2019. |