Bill Text: TX HB3232 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the authority of health benefit plan issuers to require utilization review for a health care service provided by network physicians or providers.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2019-04-16 - Left pending in committee [HB3232 Detail]
Download: Texas-2019-HB3232-Introduced.html
| 86R13778 SCL-D | ||
| By: J. Johnson of Dallas | H.B. No. 3232 | |
|
|
||
|
|
||
| relating to the authority of health benefit plan issuers to require | ||
| utilization review for a health care service provided by network | ||
| physicians or providers. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subchapter J, Chapter 843, Insurance Code, is | ||
| amended by adding Section 843.355 to read as follows: | ||
| Sec. 843.355. UTILIZATION REVIEW FOR PARTICIPATING | ||
| PHYSICIAN OR PROVIDER PROHIBITED. A health maintenance | ||
| organization may not require utilization review, including a | ||
| preauthorization determination that a health care service is | ||
| medically necessary and appropriate, of a health care service | ||
| provided to an enrollee by a participating physician or provider. | ||
| SECTION 2. Subchapter C-1, Chapter 1301, Insurance Code, is | ||
| amended by adding Section 1301.140 to read as follows: | ||
| Sec. 1301.140. UTILIZATION REVIEW FOR PREFERRED PHYSICIAN | ||
| OR PROVIDER PROHIBITED. (a) In this section, "utilization review" | ||
| has the meaning assigned by Section 4201.002. | ||
| (b) An insurer may not require utilization review, | ||
| including preauthorization, of a medical care or health care | ||
| service provided to an insured by a preferred physician or | ||
| provider. | ||
| SECTION 3. Sections 843.348 and 1301.135, Insurance Code, | ||
| are repealed. | ||
| 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, 2020. A health benefit plan delivered, issued | ||
| for delivery, or renewed before January 1, 2020, 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, 2019. | ||
