Bill > HB1635

This bill modifies the definition of "emergency care" across multiple sections of the Texas Insurance Code to clarify that emergency medical services should be evaluated based on a patient's initial symptoms and perceived severity, regardless of the final medical diagnosis. Specifically, the bill adds language specifying that emergency care should be considered valid "regardless of the final diagnosis of the conditions," which means that even if subsequent medical evaluation determines a different or less severe condition than initially suspected, the original emergency care would still be considered legitimate. The bill maintains the existing standard of evaluating emergency care through a "prudent layperson" standard, which considers whether a person with average medical knowledge would believe their condition requires immediate medical attention to prevent serious health risks like bodily harm, organ dysfunction, or serious jeopardy to health. The changes will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, and the bill itself will take effect on September 1, 2025. Additionally, the bill expands the definition of "utilization review" to explicitly include determining whether services meet the definition of emergency care, which could impact how health insurance providers assess emergency medical claims.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB1635