Bill > HB1818

This bill enhances the Texas Insurance Commissioner's authority to examine health maintenance organizations (HMOs) and insurers for compliance with utilization review and preauthorization requirements. It mandates that the Commissioner conduct at least one annual examination of HMOs and insurers to ensure they are following regulations related to reviewing and approving healthcare services, including requirements specified in several Texas Insurance Code chapters. The bill allows the Commissioner flexibility in conducting these examinations, noting that if a comprehensive review is already planned as part of another examination in a given year, a separate annual examination may not be necessary. The bill also specifies that documentation provided during these examinations is confidential and not subject to public disclosure. Additionally, the bill authorizes HMOs to be charged a fee for the expenses of these examinations, which will cover the actual salaries and expenses of the examiners. The term "utilization review" is defined according to existing state law, and the bill is set to take effect on September 1, 2025.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB1818