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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of certain information about physicians |
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and nurses making determinations regarding requests for |
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preauthorization of health care services or supplies. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter G, Chapter 4201, Insurance Code, is |
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amended by adding Section 4201.3025 to read as follows: |
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Sec. 4201.3025. PREAUTHORIZATION DETERMINATION: REQUIRED |
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PHYSICIAN INFORMATION. A utilization review agent shall include in |
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any written documentation that records a utilization review |
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determination made regarding a request for preauthorization, as |
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defined by Section 4201.651, or a determination made in an appeal of |
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an adverse determination made regarding a request for |
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preauthorization: |
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(1) the signature of the physician or nurse making the |
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determination; |
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(2) the full printed name of the physician or nurse; |
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(3) a unique provider identifier number for the |
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physician or nurse, such as a national provider identifier; |
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(4) the credentials of the physician or nurse, |
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including board certification and area of specialty expertise and |
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training, as applicable; |
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(5) attestation by the physician or nurse that the |
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physician or nurse has appropriate training and expertise in the |
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field of medicine that is sufficient to make an informed decision |
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regarding the medical necessity or appropriateness of the health |
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care service or supply proposed to be provided to the patient; |
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(6) attestation by the physician or nurse that the |
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physician or nurse does not have a conflict of interest that would |
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interfere with the physician's or nurse's ability to make an |
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impartial determination based on the merits of the specific patient |
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case; and |
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(7) the amount of time the physician or nurse spent |
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evaluating medical records or other information related to the |
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review or appeal before making the determination. |
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SECTION 2. Section 4201.3025, Insurance Code, as added by |
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this Act, applies only to a request for preauthorization made on or |
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after January 1, 2026, under a health benefit plan delivered, |
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issued for delivery, or renewed on or after that date. |
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SECTION 3. This Act takes effect September 1, 2025. |