88R4212 KBB-F
 
  By: Schwertner S.B. No. 1139
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the definition of emergency care for purposes of
  certain health benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 843.002(7), Insurance Code, is amended
  to read as follows:
               (7)  "Emergency care" means health care services
  provided in a hospital emergency facility, freestanding emergency
  medical care facility, or comparable emergency facility to evaluate
  and stabilize medical conditions of a recent onset and severity,
  including severe pain, regardless of the final diagnosis of the
  conditions, that would lead a prudent layperson possessing an
  average knowledge of medicine and health to believe that the
  individual's condition, sickness, or injury is of such a nature
  that failure to get immediate medical care could:
                     (A)  place the individual's health in serious
  jeopardy;
                     (B)  result in serious impairment to bodily
  functions;
                     (C)  result in serious dysfunction of a bodily
  organ or part;
                     (D)  result in serious disfigurement; or
                     (E)  for a pregnant woman, result in serious
  jeopardy to the health of the fetus.
         SECTION 2.  Section 1301.155(a), Insurance Code, is amended
  to read as follows:
         (a)  In this section, "emergency care" means health care
  services provided in a hospital emergency facility, freestanding
  emergency medical care facility, or comparable emergency facility
  to evaluate and stabilize a medical condition of a recent onset and
  severity, including severe pain, regardless of the final diagnosis
  of the condition, that would lead a prudent layperson possessing an
  average knowledge of medicine and health to believe that the
  person's condition, sickness, or injury is of such a nature that
  failure to get immediate medical care could result in:
               (1)  placing the person's health in serious jeopardy;
               (2)  serious impairment to bodily functions;
               (3)  serious dysfunction of a bodily organ or part;
               (4)  serious disfigurement; or
               (5)  in the case of a pregnant woman, serious jeopardy
  to the health of the fetus.
         SECTION 3.  Sections 4201.002(2) and (13), Insurance Code,
  are amended to read as follows:
               (2)  "Emergency care" means health care services
  provided in a hospital emergency facility or comparable facility to
  evaluate and stabilize medical conditions of a recent onset and
  severity, including severe pain, regardless of the final diagnosis
  of the conditions, that would lead a prudent layperson possessing
  an average knowledge of medicine and health to believe that the
  individual's condition, sickness, or injury is of such a nature
  that failure to get immediate medical care could:
                     (A)  place the individual's health in serious
  jeopardy;
                     (B)  result in serious impairment to bodily
  functions;
                     (C)  result in serious dysfunction of a bodily
  organ or part;
                     (D)  result in serious disfigurement; or
                     (E)  for a pregnant woman, result in serious
  jeopardy to the health of the fetus.
               (13)  "Utilization review" includes a system for
  prospective, concurrent, or retrospective review of the medical
  necessity and appropriateness of health care services, including a
  determination that the services do not meet the definition of
  emergency care, and a system for prospective, concurrent, or
  retrospective review to determine the experimental or
  investigational nature of health care services. The term does not
  include a review in response to an elective request for
  clarification of coverage.
         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, 2024. A health benefit plan delivered, issued
  for delivery, or renewed before January 1, 2024, 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, 2023.