Bill Text: TX HB4067 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to examinations of health maintenance organizations and insurers by the commissioner of insurance regarding compliance with certain utilization review and preauthorization requirements; authorizing a fee.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-04-04 - Left pending in committee [HB4067 Detail]
Download: Texas-2023-HB4067-Introduced.html
88R9251 KBB-F | ||
By: Vo | H.B. No. 4067 |
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relating to examinations of health maintenance organizations and | ||
insurers by the commissioner of insurance regarding compliance with | ||
certain utilization review and preauthorization requirements; | ||
authorizing a fee. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 843.154(f), Insurance Code, is amended | ||
to read as follows: | ||
(f) A health maintenance organization shall pay to the | ||
commissioner a fee in an amount assessed by the commissioner and | ||
paid in accordance with rules adopted by the commissioner for the | ||
expenses of an examination under Section 843.156(a) or (a-1) that: | ||
(1) are incurred by the commissioner or under the | ||
commissioner's authority; and | ||
(2) are directly attributable to that examination, | ||
including the actual salaries and expenses of the examiners | ||
directly attributable to that examination, as determined under | ||
rules adopted by the commissioner. | ||
SECTION 2. Section 843.156, Insurance Code, is amended by | ||
adding Subsections (a-1) and (a-2) to read as follows: | ||
(a-1) The commissioner shall examine a health maintenance | ||
organization to determine the health maintenance organization's | ||
compliance with applicable requirements related to utilization | ||
review, including requirements under this chapter, Chapter 1222, | ||
Chapter 1369, and Chapter 4201 that relate to the preauthorization | ||
of health care services. The commissioner may conduct an | ||
examination under this subsection as often as the commissioner | ||
considers necessary but shall conduct an examination at least once | ||
annually. Documentation provided to the commissioner during an | ||
examination conducted under this subsection is confidential and is | ||
not subject to disclosure as public information under Chapter 552, | ||
Government Code. In this subsection and Subsection (a-2), | ||
"utilization review" has the meaning assigned by Section 4201.002. | ||
(a-2) If in a certain year the commissioner examines or will | ||
examine a health maintenance organization's compliance with | ||
applicable requirements related to utilization review as part of an | ||
examination other than the examination required by Subsection | ||
(a-1), the commissioner is not required to examine the health | ||
maintenance organization under Subsection (a-1) in that year. | ||
SECTION 3. Section 1301.0056, Insurance Code, is amended by | ||
adding Subsections (a-1) and (a-2) to read as follows: | ||
(a-1) The commissioner shall examine an insurer to | ||
determine the insurer's compliance with applicable requirements | ||
related to utilization review, including requirements under this | ||
chapter, Chapter 1222, Chapter 1369, and Chapter 4201 that relate | ||
to the preauthorization of medical care or health care services. | ||
The commissioner may conduct an examination under this subsection | ||
as often as the commissioner considers necessary but shall conduct | ||
an examination at least once annually. In this subsection and | ||
Subsection (a-2), "utilization review" has the meaning assigned by | ||
Section 4201.002. | ||
(a-2) If in a certain year the commissioner examines or will | ||
examine an insurer's compliance with applicable requirements | ||
related to utilization review as part of an examination other than | ||
the examination required by Subsection (a-1), the commissioner is | ||
not required to examine the insurer under Subsection (a-1) in that | ||
year. | ||
SECTION 4. This Act takes effect September 1, 2023. |