Bill Text: TX HB4367 | 2023-2024 | 88th Legislature | Engrossed
Bill Title: Relating to the preauthorization of medical or health care services by a health maintenance organization or an insurer.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2023-05-05 - Referred to Health & Human Services [HB4367 Detail]
Download: Texas-2023-HB4367-Engrossed.html
88R22032 CJD-D | ||
By: Cortez | H.B. No. 4367 |
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relating to the preauthorization of medical or health care services | ||
by a health maintenance organization or an insurer. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 843.348, Insurance Code, is amended by | ||
amending Subsection (g) and adding Subsection (g-1) to read as | ||
follows: | ||
(g) Unless a physician or provider has materially | ||
misrepresented the proposed health care services or has | ||
substantially failed to perform the proposed health care services, | ||
if [ |
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health care services, the health maintenance organization may not | ||
deny or reduce payment to the physician or provider for those | ||
services based on: | ||
(1) medical necessity or appropriateness of care; or | ||
(2) eligibility or coverage determinations if the | ||
proposed health care service is provided to the enrollee before the | ||
31st day after the date the health care service was preauthorized | ||
and coverage is not terminated during that period [ |
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(g-1) Notwithstanding Section 843.347 or any other law, and | ||
for the purposes of Subsection (g), a health maintenance | ||
organization may not require that the physician or provider request | ||
verification. | ||
SECTION 2. Section 1301.135, Insurance Code, is amended by | ||
amending Subsection (f) and adding Subsection (f-1) to read as | ||
follows: | ||
(f) Unless a physician or health care provider has | ||
materially misrepresented the proposed medical or health care | ||
services or has substantially failed to perform the proposed | ||
medical or health care services, if [ |
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preauthorized medical care or health care services, the insurer may | ||
not deny or reduce payment to the physician or [ |
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provider for those services based on: | ||
(1) medical necessity or appropriateness of care; or | ||
(2) eligibility or coverage determinations if the | ||
proposed medical or health care service is provided to the insured | ||
before the 31st day after the date the medical or health care | ||
service was preauthorized and coverage is not terminated during | ||
that period [ |
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(f-1) Notwithstanding Section 1301.133 or any other law, | ||
and for the purposes of Subsection (f), an insurer may not require | ||
that the physician or health care provider request verification. | ||
SECTION 3. The changes in law made by this Act apply only to | ||
a request for preauthorization of medical care or health care | ||
services made on or after January 1, 2024, under a health benefit | ||
plan delivered, issued for delivery, or renewed on or after that | ||
date. A request for preauthorization of medical care or health care | ||
services made before January 1, 2024, or on or after January 1, | ||
2024, under a health benefit plan delivered, issued for delivery, | ||
or renewed before that date, 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 4. This Act takes effect September 1, 2023. |