Bill > SB622

This bill modifies the definition of "emergency care" in multiple sections of the Texas Insurance Code to clarify that emergency medical services should be evaluated based on the patient's initial symptoms and perceived severity, regardless of the final medical diagnosis. Specifically, the bill adds language stating that emergency care should be considered "regardless of the final diagnosis of the conditions" when determining whether a medical situation meets the emergency care definition. The bill maintains the existing standard that emergency care involves medical services provided in emergency facilities where a "prudent layperson" would believe immediate medical attention is necessary to prevent serious health risks, such as potential serious jeopardy to health, serious impairment of bodily functions, organ dysfunction, serious disfigurement, or in the case of pregnant women, risks to fetal health. Additionally, the bill includes a provision that expands the definition of "utilization review" to explicitly allow for determining whether services meet the emergency care definition. The changes will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, and the act itself will take effect on September 1, 2025.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB622