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A BILL TO BE ENTITLED
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AN ACT
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relating to examinations of health maintenance organizations and |
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insurers by the commissioner of insurance regarding compliance with |
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certain utilization review and preauthorization requirements; |
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authorizing a fee. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.154(f), Insurance Code, is amended |
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to read as follows: |
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(f) A health maintenance organization shall pay to the |
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commissioner a fee in an amount assessed by the commissioner and |
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paid in accordance with rules adopted by the commissioner for the |
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expenses of an examination under Section 843.156(a) or (a-1) that: |
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(1) are incurred by the commissioner or under the |
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commissioner's authority; and |
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(2) are directly attributable to that examination, |
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including the actual salaries and expenses of the examiners |
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directly attributable to that examination, as determined under |
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rules adopted by the commissioner. |
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SECTION 2. Section 843.156, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) to read as follows: |
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(a-1) The commissioner shall examine a health maintenance |
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organization to determine the health maintenance organization's |
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compliance with applicable requirements related to utilization |
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review, including requirements under this chapter, Chapter 1222, |
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Chapter 1369, and Chapter 4201 that relate to the preauthorization |
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of health care services. The commissioner may conduct an |
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examination under this subsection as often as the commissioner |
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considers necessary but shall conduct an examination at least once |
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annually. Documentation provided to the commissioner during an |
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examination conducted under this subsection is confidential and is |
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not subject to disclosure as public information under Chapter 552, |
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Government Code. In this subsection and Subsection (a-2), |
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"utilization review" has the meaning assigned by Section 4201.002. |
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(a-2) If in a certain year the commissioner examines or will |
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examine a health maintenance organization's compliance with |
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applicable requirements related to utilization review as part of an |
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examination other than the examination required by Subsection |
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(a-1), the commissioner is not required to examine the health |
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maintenance organization under Subsection (a-1) in that year. |
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SECTION 3. Section 1301.0056, Insurance Code, is amended by |
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adding Subsections (a-1) and (a-2) to read as follows: |
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(a-1) The commissioner shall examine an insurer to |
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determine the insurer's compliance with applicable requirements |
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related to utilization review, including requirements under this |
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chapter, Chapter 1222, Chapter 1369, and Chapter 4201 that relate |
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to the preauthorization of medical care or health care services. |
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The commissioner may conduct an examination under this subsection |
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as often as the commissioner considers necessary but shall conduct |
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an examination at least once annually. In this subsection and |
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Subsection (a-2), "utilization review" has the meaning assigned by |
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Section 4201.002. |
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(a-2) If in a certain year the commissioner examines or will |
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examine an insurer's compliance with applicable requirements |
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related to utilization review as part of an examination other than |
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the examination required by Subsection (a-1), the commissioner is |
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not required to examine the insurer under Subsection (a-1) in that |
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year. |
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SECTION 4. This Act takes effect September 1, 2023. |