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A BILL TO BE ENTITLED
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AN ACT
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relating to telephone access for certain health benefit plan |
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verifications and preauthorization requests and for utilization |
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review requests. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.347(c), Insurance Code, is amended |
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to read as follows: |
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(c) A health maintenance organization shall have |
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appropriate personnel reasonably available at a toll-free |
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telephone number to provide a verification under this section 24 |
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hours a day, seven days a week, including [between 6 a.m. and 6 p.m. |
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central time Monday through Friday on each day that is not a legal |
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holiday and between 9 a.m. and noon central time on Saturday, |
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Sunday, and] legal holidays. A health maintenance organization |
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must: |
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(1) have a telephone system capable of accepting or |
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recording incoming phone calls for verifications during any period |
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in which personnel are not available due to circumstances beyond |
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the health maintenance organization's reasonable control; [after 6 |
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p.m. central time Monday through Friday and after noon central time |
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on Saturday, Sunday, and legal holidays] and |
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(2) respond [responding] to each of those calls as |
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soon as possible but not later than two hours after [on or before |
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the second calendar day after the date] the call is received. |
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SECTION 2. Section 843.348(f), Insurance Code, is amended |
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to read as follows: |
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(f) A health maintenance organization shall have |
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appropriate personnel reasonably available at a toll-free |
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telephone number to respond to requests for a preauthorization 24 |
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hours a day, seven days a week, including [between 6 a.m. and 6 p.m. |
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central time Monday through Friday on each day that is not a legal |
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holiday and between 9 a.m. and noon central time on Saturday, |
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Sunday, and] legal holidays. A health maintenance organization |
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must: |
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(1) have a telephone system capable of accepting or |
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recording incoming phone calls for preauthorizations during any |
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period in which personnel are not available due to circumstances |
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beyond the health maintenance organization's reasonable control; |
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[after 6 p.m. central time Monday through Friday and after noon |
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central time on Saturday, Sunday, and legal holidays] and |
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(2) respond [responding] to each of those calls as |
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soon as possible but not later than two [24] hours after the call is |
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received. |
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SECTION 3. Section 1301.133(c), Insurance Code, is amended |
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to read as follows: |
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(c) An insurer shall have appropriate personnel reasonably |
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available at a toll-free telephone number to provide a verification |
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under this section 24 hours a day, seven days a week, including |
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[between 6 a.m. and 6 p.m. central time Monday through Friday on |
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each day that is not a legal holiday and between 9 a.m. and noon |
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central time on Saturday, Sunday, and] legal holidays. An insurer |
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must: |
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(1) have a telephone system capable of accepting or |
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recording incoming phone calls for verifications during any period |
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in which personnel are not available due to circumstances beyond |
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the insurer's reasonable control; [after 6 p.m. central time Monday |
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through Friday and after noon central time on Saturday, Sunday, and |
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legal holidays] and |
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(2) respond [responding] to each of those calls as |
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soon as possible but not later than two hours after [on or before |
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the second calendar day after the date] the call is received. |
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SECTION 4. Section 1301.135(e), Insurance Code, is amended |
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to read as follows: |
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(e) An insurer shall have appropriate personnel reasonably |
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available at a toll-free telephone number to respond to requests |
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for a preauthorization 24 hours a day, seven days a week, including |
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[between 6 a.m. and 6 p.m. central time Monday through Friday on |
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each day that is not a legal holiday and between 9 a.m. and noon |
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central time on Saturday, Sunday, and] legal holidays. An insurer |
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must: |
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(1) have a telephone system capable of accepting or |
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recording incoming phone calls for preauthorizations during any |
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period in which personnel are not available due to circumstances |
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beyond the insurer's reasonable control; [after 6 p.m. central time |
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Monday through Friday and after noon central time on Saturday, |
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Sunday, and legal holidays] and |
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(2) respond [responding] to each of those calls as |
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soon as possible but not later than two [24] hours after the call is |
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received. |
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SECTION 5. Section 4201.004(a), Insurance Code, is amended |
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to read as follows: |
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(a) A utilization review agent shall: |
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(1) have appropriate personnel reasonably available, |
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by toll-free telephone 24 hours a day, seven days a week, including |
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legal holidays [at least 40 hours per week during normal business |
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hours in this state], to discuss patients' care and allow response |
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to telephone review requests; |
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(2) have a telephone system capable, during any period |
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in which personnel are not available due to circumstances beyond |
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the utilization review agent's reasonable control [hours other than |
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normal business hours], of accepting or recording incoming |
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telephone calls or of providing instructions to a caller; and |
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(3) respond to a call made during a period described by |
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Subdivision (2) as soon as possible but [hours other than normal |
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business hours] not later than two hours [the second working day] |
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after the call is received [later of: |
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[(A) the date the call was received; or |
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[(B) the date the details necessary to respond |
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have been received from the caller]. |
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SECTION 6. This Act takes effect September 1, 2025. |