| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the authority of health benefit plan issuers to require |
|
|
utilization review for a health care service provided by network |
|
|
physicians or providers. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter J, Chapter 843, Insurance Code, is |
|
|
amended by adding Section 843.355 to read as follows: |
|
|
Sec. 843.355. UTILIZATION REVIEW FOR PARTICIPATING |
|
|
PHYSICIAN OR PROVIDER PROHIBITED. A health maintenance |
|
|
organization may not require utilization review, including a |
|
|
preauthorization determination that a health care service is |
|
|
medically necessary and appropriate, of a health care service |
|
|
provided to an enrollee by a participating physician or provider. |
|
|
SECTION 2. Subchapter C-1, Chapter 1301, Insurance Code, is |
|
|
amended by adding Section 1301.140 to read as follows: |
|
|
Sec. 1301.140. UTILIZATION REVIEW FOR PREFERRED PHYSICIAN |
|
|
OR PROVIDER PROHIBITED. (a) In this section, "utilization review" |
|
|
has the meaning assigned by Section 4201.002. |
|
|
(b) An insurer may not require utilization review, |
|
|
including preauthorization, of a medical care or health care |
|
|
service provided to an insured by a preferred physician or |
|
|
provider. |
|
|
SECTION 3. Sections 843.348 and 1301.135, Insurance Code, |
|
|
are repealed. |
|
|
SECTION 4. The changes in law made by this Act apply 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 5. This Act takes effect September 1, 2019. |