Bill Text: TX HB3041 | 2019-2020 | 86th Legislature | Enrolled
Bill Title: Relating to the renewal of a preauthorization for a medical or health care service.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-07 - Effective on 9/1/19 [HB3041 Detail]
Download: Texas-2019-HB3041-Enrolled.html
| H.B. No. 3041 | ||
|
|
||
| relating to the renewal of a preauthorization for a medical or | ||
| health care service. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle A, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1222 to read as follows: | ||
| CHAPTER 1222. PREAUTHORIZATION FOR MEDICAL OR HEALTH CARE SERVICE | ||
| Sec. 1222.0001. DEFINITIONS. In this chapter: | ||
| (1) "Health benefit plan" means a plan to which this | ||
| chapter applies under Section 1222.0002. | ||
| (2) "Health benefit plan issuer" means an entity | ||
| authorized under this code or another insurance law of this state | ||
| that provides health insurance or health benefits in this state. | ||
| (3) "Preauthorization" has the meaning assigned by | ||
| Section 1301.001. | ||
| Sec. 1222.0002. APPLICABILITY OF CHAPTER. (a) This | ||
| chapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses incurred as a result of a | ||
| health condition, accident, or sickness, including an individual, | ||
| group, blanket, or franchise insurance policy or insurance | ||
| agreement, a group hospital service contract, or an individual or | ||
| group evidence of coverage or similar coverage document that is | ||
| issued by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this chapter applies to: | ||
| (1) a small employer health benefit plan subject to | ||
| Chapter 1501, including coverage provided through a health group | ||
| cooperative under Subchapter B of that chapter; | ||
| (2) a standard health benefit plan issued under | ||
| Chapter 1507; | ||
| (3) a basic coverage plan under Chapter 1551; | ||
| (4) a basic plan under Chapter 1575; | ||
| (5) a primary care coverage plan under Chapter 1579; | ||
| (6) a plan providing basic coverage under Chapter | ||
| 1601; | ||
| (7) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (9) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 533, Government Code; | ||
| (10) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (11) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; and | ||
| (12) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code. | ||
| Sec. 1222.0003. PREAUTHORIZATION RENEWAL REQUEST. A health | ||
| benefit plan issuer that requires preauthorization as a condition | ||
| of payment for a medical or health care service shall provide a | ||
| preauthorization renewal process that allows a renewal of an | ||
| existing preauthorization to be requested by a physician or health | ||
| care provider at least 60 days before the date the preauthorization | ||
| expires. | ||
| Sec. 1222.0004. DETERMINATION REQUIRED. If a health | ||
| benefit plan issuer receives a preauthorization renewal request | ||
| before the existing preauthorization expires, the health benefit | ||
| plan issuer shall, if practicable, review the request and issue a | ||
| determination indicating whether the medical or health care service | ||
| is preauthorized before the existing preauthorization expires. | ||
| SECTION 2. The change in law made by this Act applies only | ||
| to a health benefit plan that is delivered, issued for delivery, or | ||
| renewed on or after January 1, 2020. A health benefit plan that is | ||
| 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 3. This Act takes effect September 1, 2019. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I certify that H.B. No. 3041 was passed by the House on May 2, | ||
| 2019, by the following vote: Yeas 119, Nays 21, 1 present, not | ||
| voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| I certify that H.B. No. 3041 was passed by the Senate on May | ||
| 22, 2019, by the following vote: Yeas 30, Nays 1. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| APPROVED: _____________________ | ||
| Date | ||
| _____________________ | ||
| Governor | ||
