Bill Text: TX HB4326 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to the direction of utilization review by physicians.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2023-03-21 - Referred to Public Health [HB4326 Detail]
Download: Texas-2023-HB4326-Introduced.html
88R4688 BEE/SCL-D | ||
By: Bonnen | H.B. No. 4326 |
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relating to the direction of utilization review by physicians. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 4201.152, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 4201.152. UTILIZATION REVIEW UNDER DIRECTION OF | ||
PHYSICIAN. A utilization review agent shall conduct utilization | ||
review under the direction of a physician licensed to practice | ||
medicine in this state. The physician may not hold a license to | ||
practice administrative medicine under Section 155.009, | ||
Occupations Code. | ||
SECTION 2. Subchapter M, Chapter 4201, Insurance Code, is | ||
amended by adding Section 4201.6015 to read as follows: | ||
Sec. 4201.6015. INQUIRY BY TEXAS MEDICAL BOARD. (a) If the | ||
Texas Medical Board believes that a physician has directed a | ||
utilization review in an arbitrary manner or without a medical | ||
basis or receives a complaint with that allegation, the Texas | ||
Medical Board: | ||
(1) shall notify the physician of the allegation; and | ||
(2) may compel the production of documents or other | ||
information as necessary to determine whether the utilization | ||
review was directed in an arbitrary manner or without a medical | ||
basis. | ||
(b) An inquiry and determination under this section is | ||
limited to whether the utilization review was directed in an | ||
arbitrary manner or without a medical basis in accordance with the | ||
standards of medical practice. If the commissioner initiates a | ||
proceeding under Section 4201.601 in relation to the same | ||
utilization review for which the inquiry is being conducted, the | ||
Texas Medical Board shall suspend the inquiry until the conclusion | ||
of the commissioner's proceeding. | ||
SECTION 3. The heading to Section 4201.602, Insurance Code, | ||
is amended to read as follows: | ||
Sec. 4201.602. ENFORCEMENT PROCEEDINGS [ |
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SECTION 4. Section 4201.602(a), Insurance Code, is amended | ||
to read as follows: | ||
(a) The commissioner may initiate a proceeding under | ||
Section 4201.601 [ |
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initiate a proceeding under Section 4201.6015. | ||
SECTION 5. Section 4201.603, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 4201.603. REMEDIES AND PENALTIES; EMERGENCY REMEDIES | ||
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utilization review agent, health maintenance organization, | ||
insurer, or other person or entity conducting utilization review | ||
has violated or is violating this chapter, the commissioner may: | ||
(1) impose a sanction under Chapter 82; | ||
(2) issue a cease and desist order under Chapter 83; or | ||
(3) assess an administrative penalty under Chapter 84. | ||
(b) The Texas Medical Board may restrict, suspend, or revoke | ||
the license of a physician the board determines has directed a | ||
utilization review in an arbitrary manner or without a medical | ||
basis at the conclusion of a proceeding conducted under Section | ||
4201.6015. | ||
(c) If a utilization review results in the serious injury or | ||
death of the individual who is the subject of the review, the | ||
commissioner may temporarily prohibit a physician who directed the | ||
review from directing utilization review and the Texas Medical | ||
Board may temporarily suspend the physician's license. The | ||
commissioner or Texas Medical Board, as applicable, shall conduct a | ||
proceeding under Section 4201.601 or 4201.6015, as applicable, | ||
regarding the utilization review, and the prohibition or suspension | ||
is effective until the conclusion of the proceeding. | ||
SECTION 6. Section 151.002(a)(13), Occupations Code, is | ||
amended to read as follows: | ||
(13) "Practicing medicine" means: | ||
(A) the diagnosis, treatment, or offer to treat a | ||
mental or physical disease or disorder or a physical deformity or | ||
injury by any system or method, or the attempt to effect cures of | ||
those conditions, by a person who: | ||
(i) [ |
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physician or surgeon; or | ||
(ii) [ |
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money or other compensation for those services; and | ||
(B) the direction of utilization review | ||
conducted by a utilization review agent under Section 4201.152, | ||
Insurance Code. | ||
SECTION 7. The change in law made by this Act applies only | ||
to utilization review conducted on or after the effective date of | ||
this Act. Utilization review conducted before the effective date of | ||
this Act 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 8. This Act takes effect September 1, 2023. |