Bill Text: TX HB3412 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to preauthorization by certain health benefit plan issuers of certain covered benefits under the health benefit plan.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-04-25 - No action taken in committee [HB3412 Detail]
Download: Texas-2017-HB3412-Introduced.html
85R13312 BEE-D | ||
By: Shaheen | H.B. No. 3412 |
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relating to preauthorization by certain health benefit plan issuers | ||
of certain covered benefits under the health benefit plan. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is | ||
amended by adding Section 843.324 to read as follows: | ||
Sec. 843.324. PREAUTHORIZATION OF CERTAIN COVERED | ||
BENEFITS; WAIVER. (a) The commissioner by rule shall: | ||
(1) specify covered benefits provided to an enrollee | ||
under a health care plan for which the health maintenance | ||
organization is prohibited from requiring a physician or provider | ||
to obtain preauthorization from the health maintenance | ||
organization in order for the health maintenance organization to | ||
pay for the benefit; and | ||
(2) establish a simple procedure under which a | ||
physician or provider may obtain a waiver of a health maintenance | ||
organization's preauthorization requirement for a covered benefit | ||
under circumstances specified by rule. | ||
(b) Rules adopted under Subsection (a) must provide that the | ||
following covered benefits are not subject to preauthorization or | ||
are subject to a waiver of preauthorization requirements: | ||
(1) if a physician or provider determines that an | ||
enrollee has an immediate need for the covered benefit: | ||
(A) durable medical equipment, including | ||
crutches and wheelchairs; or | ||
(B) diagnostic testing; or | ||
(2) another health care service under circumstances | ||
that take into account: | ||
(A) symptoms displayed by the enrollee; | ||
(B) the relationship between the physician or | ||
provider and the enrollee, including the length of the | ||
relationship; and | ||
(C) the professional experience of the physician | ||
or provider. | ||
SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is | ||
amended by adding Section 1301.070 to read as follows: | ||
Sec. 1301.070. PREAUTHORIZATION OF CERTAIN COVERED | ||
BENEFITS; WAIVER. (a) The commissioner by rule shall: | ||
(1) specify covered benefits provided to an insured | ||
under a preferred provider benefit plan for which the insurer is | ||
prohibited from requiring a physician or health care provider to | ||
obtain preauthorization from the insurer in order for the insurer | ||
to pay for the benefit; and | ||
(2) establish a simple procedure under which a | ||
physician or health care provider may obtain a waiver of an | ||
insurer's preauthorization requirement for a covered benefit under | ||
circumstances specified by rule. | ||
(b) Rules adopted under Subsection (a) must provide that the | ||
following covered benefits are not subject to preauthorization or | ||
are subject to a waiver of preauthorization requirements: | ||
(1) if a physician or health care provider determines | ||
that an insured has an immediate need for the covered benefit: | ||
(A) durable medical equipment, including | ||
crutches and wheelchairs; or | ||
(B) diagnostic testing; or | ||
(2) another health care service under circumstances | ||
that take into account: | ||
(A) symptoms displayed by the insured; | ||
(B) the relationship between the physician or | ||
health care provider and the insured, including the length of the | ||
relationship; and | ||
(C) the professional experience of the physician | ||
or health care provider. | ||
SECTION 3. 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, 2018. A health benefit plan delivered, issued | ||
for delivery, or renewed before January 1, 2018, 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, 2017. |