Bill Text: TX HB3232 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the authority of health benefit plan issuers to require utilization review for a health care service provided by network physicians or providers.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-04-16 - Left pending in committee [HB3232 Detail]
Download: Texas-2019-HB3232-Introduced.html
86R13778 SCL-D | ||
By: J. Johnson of Dallas | H.B. No. 3232 |
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relating to the authority of health benefit plan issuers to require | ||
utilization review for a health care service provided by network | ||
physicians or providers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter J, Chapter 843, Insurance Code, is | ||
amended by adding Section 843.355 to read as follows: | ||
Sec. 843.355. UTILIZATION REVIEW FOR PARTICIPATING | ||
PHYSICIAN OR PROVIDER PROHIBITED. A health maintenance | ||
organization may not require utilization review, including a | ||
preauthorization determination that a health care service is | ||
medically necessary and appropriate, of a health care service | ||
provided to an enrollee by a participating physician or provider. | ||
SECTION 2. Subchapter C-1, Chapter 1301, Insurance Code, is | ||
amended by adding Section 1301.140 to read as follows: | ||
Sec. 1301.140. UTILIZATION REVIEW FOR PREFERRED PHYSICIAN | ||
OR PROVIDER PROHIBITED. (a) In this section, "utilization review" | ||
has the meaning assigned by Section 4201.002. | ||
(b) An insurer may not require utilization review, | ||
including preauthorization, of a medical care or health care | ||
service provided to an insured by a preferred physician or | ||
provider. | ||
SECTION 3. Sections 843.348 and 1301.135, Insurance Code, | ||
are repealed. | ||
SECTION 4. The changes in law made by this Act apply only to | ||
a health benefit plan delivered, issued for delivery, or renewed on | ||
or after January 1, 2020. A health benefit plan 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 5. This Act takes effect September 1, 2019. |