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A BILL TO BE ENTITLED
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AN ACT
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relating to the renewal of a preauthorization for a medical or |
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health care service. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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by adding Chapter 1222 to read as follows: |
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CHAPTER 1222. PREAUTHORIZATION FOR MEDICAL OR HEALTH CARE SERVICE |
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Sec. 1222.0001. DEFINITIONS. In this chapter: |
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(1) "Health benefit plan" means a plan to which this |
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chapter applies under Section 1222.0002. |
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(2) "Health benefit plan issuer" means an entity |
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authorized under this code or another insurance law of this state |
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that provides health insurance or health benefits in this state. |
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(3) "Preauthorization" has the meaning assigned by |
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Section 1301.001. |
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Sec. 1222.0002. APPLICABILITY OF CHAPTER. (a) This |
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chapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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issued by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(8) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(9) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(10) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(11) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; and |
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(12) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code. |
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Sec. 1222.0003. PREAUTHORIZATION RENEWAL REQUEST. A health |
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benefit plan issuer that requires preauthorization as a condition |
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of payment for a medical or health care service shall provide a |
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preauthorization renewal process that allows a renewal of an |
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existing preauthorization to be requested by a physician or health |
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care provider |
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at least 60 days before the date the preauthorization |
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expires. |
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Sec. 1222.0004. DETERMINATION REQUIRED. If a health |
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benefit plan issuer receives a preauthorization renewal request |
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before the existing preauthorization expires, the health benefit |
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plan issuer shall, if practicable, review the request and issue a |
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determination indicating whether the medical or health care service |
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is preauthorized before the existing preauthorization expires. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2020. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2020, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 3. This Act takes effect September 1, 2019. |