The bill would amend the Insurance Code to authorize the Texas Medical Board (TMB) to conduct investigations concerning utilization reviews that have been directed in an arbitrary manner or without medical basis. The bill would require TMB to notify the physician on the complaint, authorize the collection of information pertaining to the case, initiate enforcement proceedings if necessary, and authorize the board to temporarily suspend the licenses of physicians based on the results of the review. Under current law, the Department of Insurance is currently authorized to conduct these same investigations. Under the bill's provisions, TMB would have to suspend any inquiry if the Department of Insurance initiates a proceeding on the same case. Additionally, the bill would amend portions of the Insurance Code relating to the insurance provider's ability to request exemptions from preauthorization requirements for providing certain health services.
Based on information provided by TMB, the Department of Insurance, and the State Office of Administrative Hearings, this estimate assumes that the number of cases related to this subject would be insignificant and the occurrence of these cases being escalated to a proceeding would be rare. This estimate assumes that duties and responsibilities associated with the increased workload could be accomplished by utilizing existing resources.
No significant fiscal implication to units of local government is anticipated.