By: Johnson of Dallas H.B. No. 3542
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the telephone availability of certain personnel by
  certain health benefit plan issuers and utilization review agents.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Sections 843.347(c), Insurance Code, is amended
  to read as follows:
         (c)  A health maintenance organization shall have
  appropriate personnel reasonably available at a toll-free
  telephone number to provide a verification under this section 24
  hours a day, every day of the year, including on Saturdays, Sundays,
  and legal holidays [between 6 a.m. and 6 p.m. central time Monday
  through Friday on each day that is not a legal holiday and between 9
  a.m. and noon central time on Saturday, Sunday, and legal
  holidays]. A health maintenance organization must have a telephone
  system capable of accepting or recording incoming phone calls for
  verifications during times when personnel are not available due to
  circumstances beyond the health maintenance organization's
  reasonable control [after 6 p.m. central time Monday through Friday
  and after noon central time on Saturday, Sunday, and legal
  holidays] and respond [responding] to each of those calls as soon as
  possible and in no event later than two hours after the call [on or
  before the second calendar day after the date the call] is received.
         SECTION 2.  Section 843.348(f), Insurance Code, is amended
  to read as follows:
         (f)  A health maintenance organization shall have
  appropriate personnel reasonably available at a toll-free
  telephone number to respond to requests for a preauthorization 24
  hours a day, every day of the year, including on Saturdays, Sundays,
  and legal holidays [between 6 a.m. and 6 p.m. central time Monday
  through Friday on each day that is not a legal holiday and between 9
  a.m. and noon central time on Saturday, Sunday, and legal
  holidays]. A health maintenance organization must have a telephone
  system capable of accepting or recording incoming phone calls for
  preauthorizations during times when personnel are not available due
  to circumstances beyond the health maintenance organization's
  reasonable control [after 6 p.m. central time Monday through Friday
  and after noon central time on Saturday, Sunday, and legal
  holidays] and respond [responding] to each of those calls as soon as
  possible and in no event [not] later than two [24] hours after the
  call is received.
         SECTION 3.  Section 1301.133(c), Insurance Code, is amended
  to read as follows:
         (c)  An insurer shall have appropriate personnel reasonably
  available at a toll-free telephone number to provide a verification
  under this section 24 hours a day, every day of the year, including
  on Saturdays, Sundays, and legal holidays [between 6 a.m. and 6 p.m.
  central time Monday through Friday on each day that is not a legal
  holiday and between 9 a.m. and noon central time on Saturday,
  Sunday, and legal holidays]. An insurer must have a telephone
  system capable of accepting or recording incoming phone calls for
  verifications during times when personnel are not available due to
  circumstances beyond the insurer's reasonable control [after 6 p.m.
  central time Monday through Friday and after noon central time on
  Saturday, Sunday, and legal holidays] and respond [responding] to
  each of those calls as soon as possible and in no event later than
  two hours after [on or before the second calendar day after the
  date] the call is received.
         SECTION 4.  Section 1301.135(e), Insurance Code, is amended
  to read as follows:
         (e)  An insurer shall have appropriate personnel reasonably
  available at a toll-free telephone number to respond to requests
  for a preauthorization 24 hours a day, every day of the year,
  including on Saturdays, Sundays, and legal holidays [between 6 a.m.
  and 6 p.m. central time Monday through Friday on each day that is
  not a legal holiday and between 9 a.m. and noon central time on
  Saturday, Sunday, and legal holidays]. An insurer must have a
  telephone system capable of accepting or recording incoming phone
  calls for preauthorizations during times when personnel are not
  available due to circumstances beyond the insurer's reasonable
  control [after 6 p.m. central time Monday through Friday and after
  noon central time on Saturday, Sunday, and legal holidays] and
  respond [responding] to each of those calls as soon as possible and
  in no event [not] later than two [24] hours after the call is
  received.
         SECTION 5.  Section 4201.004(a), Insurance Code is amended
  to read as follows:
         (a)  A utilization review agent shall:
               (1)  have appropriate personnel reasonably available,
  by toll-free telephone available 24 hours a day, every day of the
  year, including on Saturdays, Sundays, and legal holidays[at least
  40 hours per week during normal business hours in this state], to
  discuss patients' care and allow response to telephone review
  requests;
               (2)  have a telephone system capable, during times when
  personnel are not available due to circumstances beyond the
  utilization review agent's reasonable control[during hours other
  than normal business hours], of accepting or recording incoming
  telephone calls or of providing instructions to a caller; and
               (3)  respond to a call made during times when personnel
  are unavailable due to circumstances described in subdivision (2)
  as soon as possible and in no event [hours other than normal
  business hours not] later than two hours [the second working day]
  after the call was received[the later of:
                     (A)  the date the call was received; or
                     (B)  the date the details necessary to respond
  have been received from the caller].
         SECTION 6.  This Act takes effect September 1, 2021.