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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[(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 Subsection (a-1) to read as follows: |
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(a-1) The commissioner shall examine a health maintenance |
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organization that uses a preauthorization process for health care |
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services to determine the health maintenance organization's |
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compliance with applicable requirements of this Code related to |
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preauthorization, including requirements in this chapter, Chapter |
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1222, Chapter 1369, and Chapter 4201. A health maintenance |
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organization is subject to an examination by the commissioner under |
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this subsection at least once every year and whenever the |
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commissioner considers an examination necessary. Documentation |
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provided to the commissioner during an examination conducted under |
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this subsection is confidential and is not subject to disclosure as |
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public information under Chapter 552, Government Code. |
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SECTION 3. Section 1301.0056, Insurance Code, is amended by |
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adding Subsection (a-1) to read as follows: |
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(a-1) The commissioner shall examine an insurer that uses a |
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preauthorization process for medical care or health care services |
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to determine the insurer's compliance with applicable requirements |
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of this Code related to preauthorization, including requirements in |
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this chapter, Chapter 1222, Chapter 1369, and Chapter 4201. A |
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insurer is subject to an examination by the commissioner under this |
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subsection at least once every year and whenever the commissioner |
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considers an examination necessary. |
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SECTION 4. This Act takes effect September 1, 2021. |