By: Bonnen of Galveston H.B. No. 2387
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the regulation of utilization review, independent
  review, and peer review for health benefit plan and workers'
  compensation coverage and to preauthorization of certain medical
  care and health care services by certain health benefit plan
  issuers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.005, Government Code, is amended by
  adding Subsection (e) to read as follows:
         (e)  In addition to the requirements under Subsection (a), a
  contract described by that subsection must require the managed care
  organization to comply with Section 4201.156, Insurance Code.
         SECTION 2.  Section 843.348(b), Insurance Code, is amended
  to read as follows:
         (b)  A health maintenance organization that uses a
  preauthorization process for health care services shall provide
  each participating physician or provider, not later than the fifth
  [10th] business day after the date a request is made, a list of
  health care services that [do not] require preauthorization and
  information concerning the preauthorization process.
         SECTION 3.  Subchapter J, Chapter 843, Insurance Code, is
  amended by adding Sections 843.3481, 843.3482, 843.3483, and
  843.3484 to read as follows:
         Sec. 843.3481.  POSTING OF PREAUTHORIZATION REQUIREMENTS.
  (a) A health maintenance organization that uses a preauthorization
  process for health care services shall make the requirements and
  information about the preauthorization process readily accessible
  to enrollees, physicians, providers, and the general public by
  posting the requirements and information on the health maintenance
  organization's Internet website.
         (b)  The preauthorization requirements and information
  described by Subsection (a) must:
               (1)  be posted:
                     (A)  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;
               (2)  be written in plain language that is easily
  understandable by enrollees, physicians, 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 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;
                     (B)  a list or description of any supporting
  documentation that the health maintenance organization requires
  from the physician or provider ordering or requesting the service
  to approve a request for that service;
                     (C)  the applicable screening criteria using
  Current Procedural Terminology codes and International
  Classification of Diseases codes; and
                     (D)  statistics regarding preauthorization
  approval and denial rates for the service in the preceding year and
  for each previous year the preauthorization requirement was in
  effect, including statistics in the following categories:
                           (i)  physician or provider type and
  specialty, if any;
                           (ii)  indication offered;
                           (iii)  reasons for request denial;
                           (iv)  denials overturned on internal appeal;
                           (v)  denials overturned on external appeal;
  and
                           (vi)  total annual preauthorization
  requests, approvals, and denials for the service.
         Sec. 843.3482.  CHANGES TO PREAUTHORIZATION REQUIREMENTS.
  (a) Except as provided by Subsection (b), not later than the 60th
  day before the date a new or amended preauthorization requirement
  takes effect, a health maintenance organization that uses a
  preauthorization process for health care services shall provide
  each participating physician or provider written notice of the new
  or amended preauthorization requirement and disclose the new or
  amended requirement in the health maintenance organization's
  newsletter or network bulletin, if any.
         (b)  For a change in a preauthorization requirement or
  process that removes a service from the list of health care services
  requiring preauthorization or amends a preauthorization
  requirement in a way that is less burdensome to enrollees or
  participating physicians or providers, a health maintenance
  organization shall provide each participating physician or
  provider written notice of the change in the preauthorization
  requirement and disclose the change in the health maintenance
  organization's newsletter or network bulletin, if any, not later
  than the fifth day before the date the change takes effect.
         (c)  Not later than the fifth day before the date a new or
  amended preauthorization requirement takes effect, a health
  maintenance organization shall update its Internet website to
  disclose the change to the health maintenance organization's
  preauthorization requirements or process and the date and time the
  change is effective.
         Sec. 843.3483.  REMEDY FOR NONCOMPLIANCE; AUTOMATIC WAIVER.  
  In addition to any other penalty or remedy provided by law, a health
  maintenance organization that uses a preauthorization process for
  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,
  waives the health maintenance organization's preauthorization
  requirements with respect to any health care service affected by
  the violation, and any health care service affected by the
  violation is considered preauthorized by the health maintenance
  organization.
         Sec. 843.3484.  EFFECT OF PREAUTHORIZATION WAIVER. A waiver
  of preauthorization requirements under Section 843.3483 may not be
  construed to:
               (1)  authorize a physician or provider to provide
  health care services outside of the physician's or provider's
  applicable scope of practice as defined by state law; or
               (2)  require the health maintenance organization to pay
  for a health care service provided outside of the physician's or
  provider's applicable scope of practice as defined by state law.
         SECTION 4.  Section 1301.135(a), Insurance Code, is amended
  to read as follows:
         (a)  An insurer that uses a preauthorization process for
  medical care or [and] health care services shall provide to each
  preferred provider, not later than the fifth [10th] business day
  after the date a request is made, a list of medical care and health
  care services that require preauthorization and information
  concerning the preauthorization process.
         SECTION 5.  Subchapter C-1, Chapter 1301, Insurance Code, is
  amended by adding Sections 1301.1351, 1301.1352, 1301.1353, and
  1301.1354 to read as follows:
         Sec. 1301.1351.  POSTING OF PREAUTHORIZATION REQUIREMENTS.
  (a) An insurer that uses a preauthorization process for medical
  care or health care services shall make the requirements and
  information about the preauthorization process readily accessible
  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:
                     (A)  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;
               (2)  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:
                     (A)  the effective date of the preauthorization
  requirement;
                     (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;
                     (C)  the applicable screening criteria using
  Current Procedural Terminology codes and International
  Classification of Diseases codes; and
                     (D)  statistics regarding the insurer's
  preauthorization approval and denial rates for the medical care or
  health care service in the preceding year and for each previous year
  the preauthorization requirement was in effect, including
  statistics in the following categories:
                           (i)  physician or health care provider type
  and specialty, if any;
                           (ii)  indication offered;
                           (iii)  reasons for request denial;
                           (iv)  denials overturned on internal appeal;
                           (v)  denials overturned on external appeal;
  and
                           (vi)  total annual preauthorization
  requests, approvals, and denials for the service.
         (c)  The provisions of this section may not be waived,
  voided, or nullified by contract.
         Sec. 1301.1352.  CHANGES TO PREAUTHORIZATION REQUIREMENTS.
  (a) Except as provided by Subsection (b), not later than the 60th
  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 to each
  preferred provider written notice of the new or amended
  preauthorization requirement and disclose the new or amended
  requirement in the insurer's newsletter or network bulletin, if
  any.
         (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 each preferred provider written notice of the change in the
  preauthorization requirement and disclose the change in the
  insurer's newsletter or network bulletin, if any, not later than
  the fifth day before the date the change takes effect.
         (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.
         (d)  The provisions of this section may not be waived,
  voided, or nullified by contract.
         Sec. 1301.1353.  REMEDY FOR NONCOMPLIANCE; AUTOMATIC
  WAIVER. (a)  In addition to any other penalty or remedy provided by
  law, an insurer that uses 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, waives the insurer's preauthorization requirements with
  respect to any medical care or health care service affected by the
  violation, and any medical care or health care service affected by
  the violation is considered preauthorized by the insurer.
         (b)  The provisions of this section may not be waived,
  voided, or nullified by contract.
         Sec. 1301.1354.  EFFECT OF PREAUTHORIZATION WAIVER. (a)  A
  waiver of preauthorization requirements under Section 1301.1353
  may not be construed to:
               (1)  authorize a physician or health care provider to
  provide medical care or health care services outside of the
  physician's or health care provider's applicable scope of practice
  as defined by state law; or
               (2)  require the insurer to pay for a medical care or
  health care service provided outside of the physician's or health
  care provider's applicable scope of practice as defined by state
  law.
         (b)  The provisions of this section may not be waived,
  voided, or nullified by contract.
         SECTION 6.  Section 4201.002(12), Insurance Code, is amended
  to read as follows:
               (12)  "Provider of record" means the physician or other
  health care provider with primary responsibility for the health
  care[, treatment, and] services provided to or requested on behalf
  of an enrollee or the physician or other health care provider that
  has provided or has been requested to provide the health care
  services to the enrollee. The term includes a health care facility
  where the health care services are [if treatment is] provided on an
  inpatient or outpatient basis.
         SECTION 7.  Sections 4201.151 and 4201.152, Insurance Code,
  are amended to read as follows:
         Sec. 4201.151.  UTILIZATION REVIEW PLAN. A utilization
  review agent's utilization review plan, including reconsideration
  and appeal requirements, must be reviewed by a physician licensed
  to practice medicine in this state and conducted in accordance with
  standards developed with input from appropriate health care
  providers and approved by a physician licensed to practice medicine
  in this state.
         Sec. 4201.152.  UTILIZATION REVIEW UNDER [DIRECTION OF]
  PHYSICIAN. A utilization review agent shall conduct utilization
  review under the supervision and direction of a physician licensed
  to practice medicine in this [by a] state [licensing agency in the
  United States].
         SECTION 8.  Subchapter D, Chapter 4201, Insurance Code, is
  amended by adding Section 4201.1525 to read as follows:
         Sec. 4201.1525.  UTILIZATION REVIEW BY PHYSICIAN. (a) A
  utilization review agent that uses a physician to conduct
  utilization review may only use a physician licensed to practice
  medicine in this state.
         (b)  A payor that conducts utilization review on the payor's
  own behalf is subject to Subsection (a) as if the payor were a
  utilization review agent.
         SECTION 9.  Section 4201.153(d), Insurance Code, is amended
  to read as follows:
         (d)  Screening criteria must be used to determine only
  whether to approve the requested treatment. Before issuing an
  adverse determination, a utilization review agent must obtain a
  determination of medical necessity by referring a proposed [A]
  denial of requested treatment [must be referred] to:
               (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 in this state who is of the same or a similar specialty as
  that physician [to determine medical necessity].
         SECTION 10.  Sections 4201.155, 4201.206, and 4201.251,
  Insurance Code, are amended to read as follows:
         Sec. 4201.155.  LIMITATION ON NOTICE REQUIREMENTS AND REVIEW
  PROCEDURES. (a) A utilization review agent may not establish or
  impose a notice requirement or other review procedure that is
  contrary to the requirements of the health insurance policy or
  health benefit plan.
         (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
  ADVERSE DETERMINATION. (a) Subject to Subsection (b) and the
  notice requirements of Subchapter G, before an adverse
  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 in this state 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 in this state who is
  of the same or a similar specialty as that physician.
         Sec. 4201.251.  DELEGATION OF UTILIZATION REVIEW. A
  utilization review agent may delegate utilization review to
  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
  been delegated.
         SECTION 11.  Subchapter D, Chapter 4201, Insurance Code, is
  amended by adding Section 4201.156 to read as follows:
         Sec. 4201.156.  REVIEW PROCEDURES FOR EMERGENCY CARE CLAIMS.  
  (a)  Utilization review of an emergency care claim must be made by a
  utilization review agent who is a physician licensed under Subtitle
  B, Title 3, Occupations Code.
         (b)  With respect to an enrollee's emergency medical
  condition that is the basis for an emergency care claim, a
  utilization review agent:
               (1)  may not make an adverse determination for the
  emergency care claim predominantly based on the condition's
  classification under a Current Procedural Terminology or
  International Classification of Diseases code; and
               (2)  must review the enrollee's medical records.
         SECTION 12.  Sections 4201.252(a) and (b), Insurance Code,
  are amended to read as follows:
         (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 licensing
  requirements.
         (b)  Personnel, other than a physician licensed to practice
  medicine in this state, 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 the appropriate licensing agency in
  this state to provide the requested service.
         SECTION 13.  Section 4201.356, Insurance Code, is amended to
  read as follows:
         Sec. 4201.356.  DECISION BY PHYSICIAN REQUIRED; SPECIALTY
  REVIEW. (a) The procedures for appealing an adverse determination
  must provide that a physician licensed to practice medicine in this
  state makes the decision on the appeal, except as provided by
  Subsection (b) or (c).
         (b)  For a health care service ordered, requested, provided,
  or to be provided by a physician, the procedures for appealing an
  adverse determination must provide that a physician licensed to
  practice medicine in this state who is of the same or a similar
  specialty as that physician makes the decision on appeal, except as
  provided by Subsection (c).
         (c)  If not later than the 10th working day after the date an
  appeal is denied the enrollee's health care provider 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 this
  state to manage the medical or dental condition, procedure, or
  treatment shall review 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 14.  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. 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, provided, 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, provided, or to be
  provided by a physician, is licensed to practice medicine in this
  state.
         (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, provided, 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, provided, 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 this state
  and the health care provider must be licensed or otherwise
  authorized by the appropriate licensing agency in this state.
         SECTION 15.  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 in this state. 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 the
  appropriate licensing agency in this state.
         SECTION 16.  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 17.  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 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 in this [by
  a] state [licensing agency in the United States].
         SECTION 18.  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, provided,
  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 in this state.
         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 in this state.
         SECTION 19.  Section 4202.002, Insurance Code, is amended by
  adding Subsection (b-1) to read as follows:
         (b-1)  The standards adopted under Subsection (b)(3) must:
               (1)  ensure that personnel conducting independent
  review for a health care service are licensed or otherwise
  authorized to provide the same or a similar health care service in
  this state; and
               (2)  be consistent with the licensing laws of this
  state.
         SECTION 20.  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 21.  Subchapter B, Chapter 151, Occupations Code, is
  amended by adding Section 151.057 to read as follows:
         Sec. 151.057.  APPLICATION TO UTILIZATION REVIEW. (a) In
  this section:
               (1)  "Adverse determination" means a determination
  that health care services provided or proposed to be provided to an
  individual in this state by a physician or at the request or order
  of a physician are not medically necessary or are experimental or
  investigational.
               (2)  "Payor" has the meaning assigned by Section
  4201.002, Insurance Code.
               (3)  "Utilization review" has the meaning assigned by
  Section 4201.002, Insurance Code, and the term includes a review
  of:
                     (A)  a step therapy protocol exception request
  under Section 1369.0546, Insurance Code; and
                     (B)  prescription drug benefits under Section
  1369.056, Insurance Code.
               (4)  "Utilization review agent" means:
                     (A)  an entity that conducts utilization review
  under Chapter 4201, Insurance Code;
                     (B)  a payor that conducts utilization review on
  the payor's own behalf or on behalf of another person or entity;
                     (C)  an independent review organization certified
  under Chapter 4202, Insurance Code; or
                     (D)  a workers' compensation health care network
  certified under Chapter 1305, Insurance Code.
         (b)  A person who does the following is considered to be
  engaged in the practice of medicine in this state and is subject to
  appropriate regulation by the board:
               (1)  makes on behalf of a utilization review agent or
  directs a utilization review agent to make an adverse
  determination, including:
                     (A)  an adverse determination made on
  reconsideration of a previous adverse determination;
                     (B)  an adverse determination in an independent
  review under Subchapter I, Chapter 4201, Insurance Code;
                     (C)  a refusal to provide benefits for a
  prescription drug under Section 1369.056, Insurance Code; or
                     (D)  a denial of a step therapy protocol exception
  request under Section 1369.0546, Insurance Code;
               (2)  serves as a medical director of an independent
  review organization certified under Chapter 4202, Insurance Code;
               (3)  reviews or approves a utilization review plan
  under Section 4201.151, Insurance Code;
               (4)  supervises and directs utilization review under
  Section 4201.152, Insurance Code; or
               (5)  discusses a patient's treatment plan and the
  clinical basis for an adverse determination before the adverse
  determination is issued, as provided by Section 4201.206, Insurance
  Code.
         (c)  For purposes of Subsection (b), a denial of health care
  services based on the failure to request prospective or concurrent
  review is not considered an adverse determination.
         SECTION 22.  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 23.  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 24.  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 25.  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.
         SECTION 26.  The changes in law made by this Act to Chapters
  843 and 1301, Insurance Code, 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 27.  The changes in law made by this Act to Chapters
  1305, 4201, and 4202, Insurance Code, Chapters 408 and 413, Labor
  Code, and Chapter 151, Occupations Code, apply only to utilization,
  independent, or peer review that was 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 28.  Section 4201.156, Insurance Code, as added by
  this Act, applies only to a health benefit plan delivered, issued
  for delivery, or renewed on or after January 1, 2020.  A health
  benefit plan delivered, issued for delivery, or renewed before
  January 1, 2020, 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 29.  If before implementing any provision of this
  Act a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until
  the
  waiver or authorization is granted.
         SECTION 30.  This Act takes effect September 1, 2019.