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A BILL TO BE ENTITLED
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AN ACT
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relating to preauthorization of certain medical care and health |
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care services by certain health benefit plan issuers and to the |
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regulation of utilization review, independent review, and peer |
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review for health benefit plan and workers' compensation coverage. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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ARTICLE 1. PREAUTHORIZATION |
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SECTION 1.01. Section 843.348(b), Insurance Code, is |
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amended to read as follows: |
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(b) A health maintenance organization that uses a |
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preauthorization process for health care services shall provide |
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each participating physician or provider, not later than the fifth |
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[10th] business day after the date a request is made, a list of |
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health care services that [do not] require preauthorization and |
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information concerning the preauthorization process. |
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SECTION 1.02. Subchapter J, Chapter 843, Insurance Code, is |
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amended by adding Sections 843.3481, 843.3482, and 843.3483 to read |
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as follows: |
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Sec. 843.3481. POSTING OF PREAUTHORIZATION REQUIREMENTS. |
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(a) A health maintenance organization that uses a |
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preauthorization process for health care services shall make the |
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requirements and information about the preauthorization process |
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readily accessible to enrollees, physicians, providers, and the |
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general public by posting the requirements and information on the |
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health maintenance organization's Internet website. |
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(b) The preauthorization requirements and information |
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described by Subsection (a) must: |
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(1) be posted: |
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(A) except as provided by Subsection (c) or (d), |
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conspicuously in a location on the Internet website that does not |
|
require the use of a log-in or other input of personal information |
|
to view the information; and |
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(B) in a format that is easily searchable and |
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accessible; |
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(2) except for the screening criteria under Paragraph |
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(4)(C), be written in plain language that is easily understandable |
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by enrollees, physicians, providers, and the general public; |
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(3) include a detailed description of the |
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preauthorization process and procedure; and |
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(4) include an accurate and current list of the health |
|
care services for which the health maintenance organization |
|
requires preauthorization that includes the following information |
|
specific to each service: |
|
(A) the effective date of the preauthorization |
|
requirement; |
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(B) a list or description of any supporting |
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documentation that the health maintenance organization requires |
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from the physician or provider ordering or requesting the service |
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to approve a request for that service; |
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(C) the applicable screening criteria, which may |
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include Current Procedural Terminology codes and International |
|
Classification of Diseases codes; and |
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(D) statistics regarding preauthorization |
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approval and denial rates for the service in the preceding year, |
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including statistics in the following categories: |
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(i) physician or provider type and |
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specialty, if any; |
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(ii) indication offered; |
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(iii) reasons for request denial; |
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(iv) denials overturned on appeal; and |
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(v) total annual preauthorization |
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requests, approvals, and denials for the service. |
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(c) This section may not be construed to require a health |
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maintenance organization to provide specific information that |
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would violate any applicable copyright law or licensing agreement. |
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A health maintenance organization is required to supply, in lieu of |
|
any information withheld on the basis of copyright law or a |
|
licensing agreement, a summary of the withheld information |
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sufficient to allow a licensed physician or provider, as applicable |
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for the specific service, who has sufficient training and |
|
experience related to the service to understand the basis for the |
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health maintenance organization's medical necessity or |
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appropriateness determinations. |
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(d) If a requirement or information described by Subsection |
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(a) is licensed, proprietary, or copyrighted material that the |
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health maintenance organization has received from a third party |
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with which the health maintenance organization has contracted, the |
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health maintenance organization may, instead of making that |
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information publicly available on the health maintenance |
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organization's Internet website, provide the material to a |
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physician or provider who submits a preauthorization request using |
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a nonpublic secured Internet website link or other protected, |
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nonpublic electronic means. |
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Sec. 843.3482. CHANGES TO PREAUTHORIZATION REQUIREMENTS. |
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(a) Except as provided by Subsection (b), not later than the 60th |
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day before the date a new or amended preauthorization requirement |
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takes effect, a health maintenance organization that uses a |
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preauthorization process for health care services shall provide |
|
notice of the new or amended preauthorization requirement in the |
|
health maintenance organization's newsletter or network bulletin, |
|
if any, and on the health maintenance organization's Internet |
|
website. |
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(b) For a change in a preauthorization requirement or |
|
process that removes a service from the list of health care services |
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requiring preauthorization or amends a preauthorization |
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requirement in a way that is less burdensome to enrollees or |
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participating physicians or providers, a health maintenance |
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organization shall provide notice of the change in the |
|
preauthorization requirement in the health maintenance |
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organization's newsletter or network bulletin, if any, and on the |
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health maintenance organization's Internet website not later than |
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the fifth day before the date the change takes effect. |
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(c) Not later than the fifth day before the date a new or |
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amended preauthorization requirement takes effect, a health |
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maintenance organization shall update its Internet website to |
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disclose the change to the health maintenance organization's |
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preauthorization requirements or process and the date and time the |
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change is effective. |
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Sec. 843.3483. REMEDY FOR NONCOMPLIANCE. In addition to |
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any other penalty or remedy provided by law, a health maintenance |
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organization that uses a preauthorization process for health care |
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services that violates this subchapter with respect to a required |
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publication, notice, or response regarding its preauthorization |
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requirements, including by failing to comply with any applicable |
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deadline for the publication, notice, or response, must provide an |
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expedited appeal under Section 4201.357 for any health care service |
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affected by the violation. |
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SECTION 1.03. Section 1301.135(a), Insurance Code, is |
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amended to read as follows: |
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(a) An insurer that uses a preauthorization process for |
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medical care or [and] health care services shall provide to each |
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preferred provider, not later than the fifth [10th] business day |
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after the date a request is made, a list of medical care and health |
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care services that require preauthorization and information |
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concerning the preauthorization process. |
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SECTION 1.04. Subchapter C-1, Chapter 1301, Insurance Code, |
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is amended by adding Sections 1301.1351, 1301.1352, and 1301.1353 |
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to read as follows: |
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Sec. 1301.1351. POSTING OF PREAUTHORIZATION REQUIREMENTS. |
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(a) An insurer that uses a preauthorization process for medical |
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care or health care services shall make the requirements and |
|
information about the preauthorization process readily accessible |
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to insureds, physicians, health care providers, and the general |
|
public by posting the requirements and information on the insurer's |
|
Internet website. |
|
(b) The preauthorization requirements and information |
|
described by Subsection (a) must: |
|
(1) be posted: |
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(A) except as provided by Subsection (c) or (d), |
|
conspicuously in a location on the Internet website that does not |
|
require the use of a log-in or other input of personal information |
|
to view the information; and |
|
(B) in a format that is easily searchable and |
|
accessible; |
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(2) except for the screening criteria under Paragraph |
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(4)(C), be written in plain language that is easily understandable |
|
by insureds, physicians, health care providers, and the general |
|
public; |
|
(3) include a detailed description of the |
|
preauthorization process and procedure; and |
|
(4) include an accurate and current list of medical |
|
care and health care services for which the insurer requires |
|
preauthorization that includes the following information specific |
|
to each service: |
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(A) the effective date of the preauthorization |
|
requirement; |
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(B) a list or description of any supporting |
|
documentation that the insurer requires from the physician or |
|
health care provider ordering or requesting the service to approve |
|
a request for the service; |
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(C) the applicable screening criteria, which may |
|
include Current Procedural Terminology codes and International |
|
Classification of Diseases codes; and |
|
(D) statistics regarding the insurer's |
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preauthorization approval and denial rates for the medical care or |
|
health care service in the preceding year, including statistics in |
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the following categories: |
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(i) physician or health care provider type |
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and specialty, if any; |
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(ii) indication offered; |
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(iii) reasons for request denial; |
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(iv) denials overturned on appeal; and |
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(v) total annual preauthorization |
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requests, approvals, and denials for the service. |
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(c) This section may not be construed to require an insurer |
|
to provide specific information that would violate any applicable |
|
copyright law or licensing agreement. An insurer is required to |
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supply, in lieu of any information withheld on the basis of |
|
copyright law or a licensing agreement, a summary of the withheld |
|
information sufficient to allow a licensed physician or other |
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health care provider, as applicable for the specific service, who |
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has sufficient training and experience related to the service to |
|
understand the basis for the insurer's medical necessity or |
|
appropriateness determinations. |
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(d) If a requirement or information described by Subsection |
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(a) is licensed, proprietary, or copyrighted material that the |
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insurer has received from a third party with which the insurer has |
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contracted, the insurer may, instead of making that information |
|
publicly available on the insurer's Internet website, provide the |
|
material to a physician or health care provider who submits a |
|
preauthorization request using a nonpublic secured Internet |
|
website link or other protected, nonpublic electronic means. |
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(e) The provisions of this section may not be waived, |
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voided, or nullified by contract. |
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Sec. 1301.1352. CHANGES TO PREAUTHORIZATION REQUIREMENTS. |
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(a) Except as provided by Subsection (b), not later than the 60th |
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day before the date a new or amended preauthorization requirement |
|
takes effect, an insurer that uses a preauthorization process for |
|
medical care or health care services shall provide notice of the new |
|
or amended preauthorization requirement in the insurer's |
|
newsletter or network bulletin, if any, and on the insurer's |
|
Internet website. |
|
(b) For a change in a preauthorization requirement or |
|
process that removes a service from the list of medical care or |
|
health care services requiring preauthorization or amends a |
|
preauthorization requirement in a way that is less burdensome to |
|
insureds, physicians, or health care providers, an insurer shall |
|
provide notice of the change in the preauthorization requirement in |
|
the insurer's newsletter or network bulletin, if any, and on the |
|
insurer's Internet website not later than the fifth day before the |
|
date the change takes effect. |
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(c) Not later than the fifth day before the date a new or |
|
amended preauthorization requirement takes effect, an insurer |
|
shall update its Internet website to disclose the change to the |
|
insurer's preauthorization requirements or process and the date and |
|
time the change is effective. |
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(d) The provisions of this section may not be waived, |
|
voided, or nullified by contract. |
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Sec. 1301.1353. REMEDY FOR NONCOMPLIANCE. (a) In addition |
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to any other penalty or remedy provided by law, an insurer that uses |
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a preauthorization process for medical care or health care services |
|
that violates this subchapter with respect to a required |
|
publication, notice, or response regarding its preauthorization |
|
requirements, including by failing to comply with any applicable |
|
deadline for the publication, notice, or response, must provide an |
|
expedited appeal under Section 4201.357 for any medical care or |
|
health care service affected by the violation. |
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(b) The provisions of this section may not be waived, |
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voided, or nullified by contract. |
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ARTICLE 2. UTILIZATION, INDEPENDENT, AND PEER REVIEW |
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SECTION 2.01. Section 4201.002(12), Insurance Code, is |
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amended to read as follows: |
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(12) "Provider of record" means the physician or other |
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health care provider with primary responsibility for the health |
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care[, treatment, and] services provided to or requested on behalf |
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of an enrollee or the physician or other health care provider that |
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has provided or has been requested to provide the health care |
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services to the enrollee. The term includes a health care facility |
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where the health care services are [if treatment is] provided on an |
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inpatient or outpatient basis. |
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SECTION 2.02. Sections 4201.151 and 4201.152, Insurance |
|
Code, are amended to read as follows: |
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Sec. 4201.151. UTILIZATION REVIEW PLAN. A utilization |
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review agent's utilization review plan, including reconsideration |
|
and appeal requirements, must be reviewed by a physician licensed |
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to practice medicine in this state and conducted in accordance with |
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standards developed with input from appropriate health care |
|
providers and approved by a physician licensed to practice medicine |
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in this state. |
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Sec. 4201.152. UTILIZATION REVIEW UNDER [DIRECTION OF] |
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PHYSICIAN. A utilization review agent shall conduct utilization |
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review under the direction of a physician licensed to practice |
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medicine in this [by a] state [licensing agency in the United
|
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States]. |
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SECTION 2.03. Section 4201.153(d), Insurance Code, is |
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amended to read as follows: |
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(d) Screening criteria must be used to determine only |
|
whether to approve the requested treatment. Before issuing an |
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adverse determination, a utilization review agent must obtain a |
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determination of medical necessity and appropriateness by |
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referring a proposed [A] denial of requested treatment [must be
|
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referred] to: |
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(1) an appropriate physician, dentist, or other health |
|
care provider; or |
|
(2) if the treatment is requested, ordered, provided, |
|
or to be provided by a physician, a physician licensed to practice |
|
medicine who is of the same or a similar specialty as that physician |
|
[to determine medical necessity]. |
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SECTION 2.04. Sections 4201.155, 4201.206, and 4201.251, |
|
Insurance Code, are amended to read as follows: |
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Sec. 4201.155. LIMITATION ON NOTICE REQUIREMENTS AND REVIEW |
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PROCEDURES. (a) A utilization review agent may not establish or |
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impose a notice requirement or other review procedure that is |
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contrary to the requirements of the health insurance policy or |
|
health benefit plan. |
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(b) This section may not be construed to release a health |
|
insurance policy or health benefit plan from full compliance with |
|
this chapter or other applicable law. |
|
Sec. 4201.206. OPPORTUNITY TO DISCUSS TREATMENT BEFORE |
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ADVERSE DETERMINATION. (a) Subject to Subsection (b) and the |
|
notice requirements of Subchapter G, before an adverse |
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determination is issued by a utilization review agent who questions |
|
the medical necessity, the [or] appropriateness, or the |
|
experimental or investigational nature[,] of a health care service, |
|
the agent shall provide the health care provider who ordered, |
|
requested, provided, or is to provide the service a reasonable |
|
opportunity to discuss with a physician licensed to practice |
|
medicine the patient's treatment plan and the clinical basis for |
|
the agent's determination. |
|
(b) If the health care service described by Subsection (a) |
|
was ordered, requested, or provided, or is to be provided by a |
|
physician, the opportunity described by that subsection must be |
|
with a physician licensed to practice medicine who is of the same or |
|
a similar specialty as that physician. |
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Sec. 4201.251. DELEGATION OF UTILIZATION REVIEW. A |
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utilization review agent may delegate utilization review to |
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qualified personnel in the hospital or other health care facility |
|
in which the health care services to be reviewed were or are to be |
|
provided. The delegation does not release the agent from the full |
|
responsibility for compliance with this chapter or other applicable |
|
law, including the conduct of those to whom utilization review has |
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been delegated. |
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SECTION 2.05. Sections 4201.252(a) and (b), Insurance Code, |
|
are amended to read as follows: |
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(a) Personnel employed by or under contract with a |
|
utilization review agent to perform utilization review must be |
|
appropriately trained and qualified and meet the requirements of |
|
this chapter and other applicable law, including applicable |
|
licensing requirements. |
|
(b) Personnel, other than a physician licensed to practice |
|
medicine, who obtain oral or written information directly from a |
|
patient's physician or other health care provider regarding the |
|
patient's specific medical condition, diagnosis, or treatment |
|
options or protocols must be a nurse, physician assistant, or other |
|
health care provider qualified and licensed or otherwise authorized |
|
by law and an appropriate licensing agency in the United States to |
|
provide the requested service. |
|
SECTION 2.06. Section 4201.356, Insurance Code, is amended |
|
to read as follows: |
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Sec. 4201.356. DECISION BY PHYSICIAN REQUIRED; SPECIALTY |
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REVIEW. (a) The procedures for appealing an adverse determination |
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must provide that a physician licensed to practice medicine makes |
|
the decision on the appeal, except as provided by Subsection (b). |
|
(b) If not later than the 10th working day after the date an |
|
appeal is requested or denied the enrollee's health care provider |
|
requests [states in writing good cause for having] a particular |
|
type of specialty provider review the case, a health care provider |
|
who is of the same or a similar specialty as the health care |
|
provider who would typically manage the medical or dental |
|
condition, procedure, or treatment under consideration for review |
|
and who is licensed or otherwise authorized by the appropriate |
|
licensing agency in the United States to manage the medical or |
|
dental condition, procedure, or treatment shall review the denial |
|
or the decision denying the appeal. The specialty review must be |
|
completed within 15 working days of the date the health care |
|
provider's request for specialty review is received. |
|
SECTION 2.07. Sections 4201.357(a), (a-1), and (a-2), |
|
Insurance Code, are amended to read as follows: |
|
(a) The procedures for appealing an adverse determination |
|
must include, in addition to the written appeal, a procedure for an |
|
expedited appeal of a denial of emergency care, [or] a denial of |
|
continued hospitalization, or a denial of another service if the |
|
requesting health care provider includes a written statement with |
|
supporting documentation that the service is necessary to treat a |
|
life-threatening condition or prevent serious harm to the patient. |
|
That procedure must include a review by a health care provider who: |
|
(1) has not previously reviewed the case; [and] |
|
(2) is of the same or a similar specialty as the health |
|
care provider who would typically manage the medical or dental |
|
condition, procedure, or treatment under review in the appeal; and |
|
(3) for a review of a health care service: |
|
(A) ordered, requested, or to be provided by a |
|
health care provider who is not a physician, is licensed or |
|
otherwise authorized by an appropriate licensing agency in the |
|
United States; or |
|
(B) ordered, requested, or to be provided by a |
|
physician, is licensed to practice medicine in the United States. |
|
(a-1) The procedures for appealing an adverse determination |
|
must include, in addition to the written appeal and the appeal |
|
described by Subsection (a), a procedure for an expedited appeal of |
|
a denial of prescription drugs or intravenous infusions for which |
|
the patient is receiving benefits under the health insurance |
|
policy. That procedure must include a review by a health care |
|
provider who: |
|
(1) has not previously reviewed the case; [and] |
|
(2) is of the same or a similar specialty as the health |
|
care provider who would typically manage the medical or dental |
|
condition, procedure, or treatment under review in the appeal; and |
|
(3) for a review of a health care service: |
|
(A) ordered, requested, or to be provided by a |
|
health care provider who is not a physician, is licensed or |
|
otherwise authorized by the appropriate licensing agency in this |
|
state to provide the service in this state; or |
|
(B) ordered, requested, or to be provided by a |
|
physician, is licensed to practice medicine in this state. |
|
(a-2) An adverse determination under Section 1369.0546 is |
|
entitled to an expedited appeal. The physician or, if appropriate, |
|
other health care provider deciding the appeal must consider |
|
atypical diagnoses and the needs of atypical patient populations. |
|
The physician must be licensed to practice medicine in the United |
|
States and the health care provider must be licensed or otherwise |
|
authorized by an appropriate licensing agency in the United States. |
|
SECTION 2.08. Section 4201.359, Insurance Code, is amended |
|
by adding Subsection (c) to read as follows: |
|
(c) A physician described by Subsection (b)(2) must comply |
|
with this chapter and other applicable laws and be licensed to |
|
practice medicine. A health care provider described by Subsection |
|
(b)(2) must comply with this chapter and other applicable laws and |
|
be licensed or otherwise authorized by an appropriate licensing |
|
agency in the United States. |
|
SECTION 2.09. Sections 4201.453 and 4201.454, Insurance |
|
Code, are amended to read as follows: |
|
Sec. 4201.453. UTILIZATION REVIEW PLAN. A specialty |
|
utilization review agent's utilization review plan, including |
|
reconsideration and appeal requirements, must be: |
|
(1) reviewed by a health care provider of the |
|
appropriate specialty who is licensed or otherwise authorized to |
|
provide the specialty health care service in this state; and |
|
(2) conducted in accordance with standards developed |
|
with input from a health care provider of the appropriate specialty |
|
who is licensed or otherwise authorized to provide the specialty |
|
health care service in this state. |
|
Sec. 4201.454. UTILIZATION REVIEW UNDER DIRECTION OF |
|
PROVIDER OF SAME SPECIALTY. A specialty utilization review agent |
|
shall conduct utilization review under the direction of a health |
|
care provider who is of the same specialty as the agent and who is |
|
licensed or otherwise authorized to provide the specialty health |
|
care service in this [by a] state [licensing agency in the United
|
|
States]. |
|
SECTION 2.10. Sections 4201.455(a) and (b), Insurance Code, |
|
are amended to read as follows: |
|
(a) Personnel who are employed by or under contract with a |
|
specialty utilization review agent to perform utilization review |
|
must be appropriately trained and qualified and meet the |
|
requirements of this chapter and other applicable law of this |
|
state, including applicable licensing laws. |
|
(b) Personnel who obtain oral or written information |
|
directly from a physician or other health care provider must be a |
|
nurse, physician assistant, or other health care provider of the |
|
same specialty as the agent and who are licensed or otherwise |
|
authorized to provide the specialty health care service by a |
|
[state] licensing agency in the United States. |
|
SECTION 2.11. Sections 4201.456 and 4201.457, Insurance |
|
Code, are amended to read as follows: |
|
Sec. 4201.456. OPPORTUNITY TO DISCUSS TREATMENT BEFORE |
|
ADVERSE DETERMINATION. Subject to the notice requirements of |
|
Subchapter G, before an adverse determination is issued by a |
|
specialty utilization review agent who questions the medical |
|
necessity, the [or] appropriateness, or the experimental or |
|
investigational nature[,] of a health care service, the agent shall |
|
provide the health care provider who ordered, requested, or is to |
|
provide the service a reasonable opportunity to discuss the |
|
patient's treatment plan and the clinical basis for the agent's |
|
determination with a health care provider who is: |
|
(1) of the same specialty as the agent; and |
|
(2) licensed or otherwise authorized to provide the |
|
specialty health care service by a licensing agency in the United |
|
States. |
|
Sec. 4201.457. APPEAL DECISIONS. A specialty utilization |
|
review agent shall comply with the requirement that a physician or |
|
other health care provider who makes the decision in an appeal of an |
|
adverse determination must be: |
|
(1) of the same or a similar specialty as the health |
|
care provider who would typically manage the specialty condition, |
|
procedure, or treatment under review in the appeal; and |
|
(2) licensed or otherwise authorized to provide the |
|
health care service by a licensing agency in the United States. |
|
SECTION 2.12. Section 408.0043, Labor Code, is amended by |
|
adding Subsection (c) to read as follows: |
|
(c) Notwithstanding Subsection (b), if a health care |
|
service is requested, ordered, provided, or to be provided by a |
|
physician, a person described by Subsection (a)(1), (2), or (3) who |
|
reviews the service with respect to a specific workers' |
|
compensation case must be of the same or a similar specialty as that |
|
physician. |
|
SECTION 2.13. Section 1305.351(d), Insurance Code, is |
|
amended to read as follows: |
|
(d) A [Notwithstanding Section 4201.152, a] utilization |
|
review agent or an insurance carrier that uses doctors to perform |
|
reviews of health care services provided under this chapter, |
|
including utilization review, or peer reviews under Section |
|
408.0231(g), Labor Code, may only use doctors licensed to practice |
|
in this state. |
|
SECTION 2.14. Section 1305.355(d), Insurance Code, is |
|
amended to read as follows: |
|
(d) The department shall assign the review request to an |
|
independent review organization. An [Notwithstanding Section
|
|
4202.002, an] independent review organization that uses doctors to |
|
perform reviews of health care services under this chapter may only |
|
use doctors licensed to practice in this state. |
|
SECTION 2.15. Section 408.023(h), Labor Code, is amended to |
|
read as follows: |
|
(h) A [Notwithstanding Section 4201.152, Insurance Code, a] |
|
utilization review agent or an insurance carrier that uses doctors |
|
to perform reviews of health care services provided under this |
|
subtitle, including utilization review, may only use doctors |
|
licensed to practice in this state. |
|
SECTION 2.16. Section 413.031(e-2), Labor Code, is amended |
|
to read as follows: |
|
(e-2) An [Notwithstanding Section 4202.002, Insurance Code,
|
|
an] independent review organization that uses doctors to perform |
|
reviews of health care services provided under this title may only |
|
use doctors licensed to practice in this state. |
|
ARTICLE 3. JOINT INTERIM STUDY |
|
SECTION 3.01. CREATION OF JOINT INTERIM COMMITTEE. (a) A |
|
joint interim committee is created to study, review, and report on |
|
the use of prior authorization and utilization review processes by |
|
private health benefit plan issuers in this state, as provided by |
|
Section 3.02 of this article, and propose reforms under that |
|
section related to the transparency of and improving patient |
|
outcomes under the prior authorization and utilization review |
|
processes used by private health benefit plan issuers in this |
|
state. |
|
(b) The joint interim committee shall be composed of four |
|
senators appointed by the lieutenant governor and four members of |
|
the house of representatives appointed by the speaker of the house |
|
of representatives. |
|
(c) The lieutenant governor and speaker of the house of |
|
representatives shall each designate a co-chair from among the |
|
joint interim committee members. |
|
(d) The joint interim committee shall convene at the joint |
|
call of the co-chairs. |
|
(e) The joint interim committee has all other powers and |
|
duties provided to a special or select committee by the rules of the |
|
senate and house of representatives, by Subchapter B, Chapter 301, |
|
Government Code, and by policies of the senate and house committees |
|
on administration. |
|
SECTION 3.02. INTERIM STUDY REGARDING PRIOR AUTHORIZATION |
|
AND UTILIZATION REVIEW PROCESSES. (a) The joint interim committee |
|
created by Section 3.01 of this article shall study data and other |
|
information available from the Texas Department of Insurance, the |
|
office of public insurance counsel, or other sources the committee |
|
determines relevant to examine and analyze the transparency of and |
|
improving patient outcomes under the prior authorization and |
|
utilization review processes used by private health benefit plan |
|
issuers in this state. |
|
(b) The joint interim committee shall propose reforms based |
|
on the study required under Subsection (a) of this section to |
|
improve the transparency of and patient outcomes under prior |
|
authorization and utilization review processes in this state. |
|
(c) The joint interim committee shall prepare a report of |
|
the findings and proposed reforms. |
|
SECTION 3.03. COMMITTEE FINDINGS AND PROPOSED REFORMS. |
|
(a) Not later than December 1, 2020, the joint interim committee |
|
created under Section 3.01 of this article shall submit to the |
|
lieutenant governor, the speaker of the house of representatives, |
|
and the governor the report prepared under Section 3.02 of this |
|
article. The joint interim committee shall include in its report |
|
recommendations of specific statutory and regulatory changes that |
|
appear necessary from the committee's study under Section 3.02 of |
|
this article. |
|
(b) Not later than the 60th day after the effective date of |
|
this Act, the lieutenant governor and speaker of the house of |
|
representatives shall appoint the members of the joint interim |
|
committee in accordance with Section 3.01 of this article. |
|
SECTION 3.04. ABOLITION OF COMMITTEE. The joint interim |
|
committee created under Section 3.01 of this article is abolished |
|
and this article expires December 15, 2020. |
|
ARTICLE 4. TRANSITIONS; EFFECTIVE DATE |
|
SECTION 4.01. The changes in law made by Article 1 of this |
|
Act apply only to a request for preauthorization of medical care or |
|
health care services made on or after January 1, 2020, under a |
|
health benefit plan delivered, issued for delivery, or renewed on |
|
or after that date. A request for preauthorization of medical care |
|
or health care services made before January 1, 2020, or on or after |
|
January 1, 2020, under a health benefit plan delivered, issued for |
|
delivery, or renewed before that date is governed by the law as it |
|
existed immediately before the effective date of this Act, and that |
|
law is continued in effect for that purpose. |
|
SECTION 4.02. The changes in law made by Article 2 of this |
|
Act apply only to utilization, independent, or peer review |
|
requested on or after the effective date of this Act. Utilization, |
|
independent, or peer review requested before the effective date of |
|
this Act is governed by the law as it existed immediately before the |
|
effective date of this Act, and that law is continued in effect for |
|
that purpose. |
|
SECTION 4.03. This Act takes effect September 1, 2019. |
|
|
|
* * * * * |