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A BILL TO BE ENTITLED
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AN ACT
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relating to preauthorization requirements and examinations of |
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certain health benefit plan issuers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.154(f), Insurance Code, is amended |
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to read as follows: |
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(f) A health maintenance organization shall pay to the |
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commissioner a fee in an amount assessed by the commissioner and |
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paid in accordance with rules adopted by the commissioner for the |
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expenses of an examination under Section 843.156 [843.156(a)] that: |
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(1) are incurred by the commissioner or under the |
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commissioner's authority; and |
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(2) are directly attributable to that examination, |
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including the actual salaries and expenses of the examiners |
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directly attributable to that examination, as determined under |
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rules adopted by the commissioner. |
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SECTION 2. Section 843.156, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) to read as follows: |
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(a-1) The commissioner shall examine a health maintenance |
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organization to determine the health maintenance organization's |
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compliance with applicable requirements of this code related to |
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utilization review, including requirements in this chapter, |
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Chapter 1222, Chapter 1369, and Chapter 4201 related to |
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preauthorization of health care services. Except as provided by |
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Subsection (a-2), a health maintenance organization is subject to |
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an examination by the commissioner under this subsection at least |
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once every year and whenever the commissioner considers an |
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examination necessary. Documentation provided to the commissioner |
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during an examination conducted under this subsection is |
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confidential and is not subject to disclosure as public information |
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under Chapter 552, Government Code. In this section, "utilization |
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review" has the meaning assigned by Section 4201.002. |
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(a-2) If the commissioner has examined or will examine a |
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health maintenance organization to determine the health |
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maintenance organization's compliance with applicable requirements |
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of this code related to utilization review in another examination |
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conducted by the commissioner during the same year, the health |
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maintenance organization is not subject to an examination under |
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Subsection (a-1) that year. |
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SECTION 3. Section 1301.0056, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) to read as follows: |
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(a-1) The commissioner shall examine an insurer to |
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determine the insurer's compliance with applicable requirements of |
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this code related to utilization review, including requirements in |
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this chapter, Chapter 1222, Chapter 1369, and Chapter 4201 related |
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to preauthorization of medical care or health care services. |
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Except as provided by Subsection (a-2), an insurer is subject to an |
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examination by the commissioner under this subsection at least once |
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every year and whenever the commissioner considers an examination |
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necessary. In this section, "utilization review" has the meaning |
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assigned by Section 4201.002. |
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(a-2) If the commissioner has examined or will examine an |
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insurer to determine the insurer's compliance with applicable |
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requirements of this code related to utilization review in another |
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examination conducted by the commissioner during the same year, the |
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insurer is not subject to an examination under Subsection (a-1) |
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that year. |
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SECTION 4. This Act takes effect September 1, 2021. |