Bill > SB1380

This bill introduces new regulations for health benefit plans regarding preauthorization requirements for certain medical services. Specifically, it prohibits health maintenance organizations (HMOs) and insurers from requiring preauthorization for several types of healthcare services, including emergency care, intervention-necessary care provided by licensed physicians, outpatient mental health and substance use disorder treatments, certain eye treatments, preventive services recommended by the U.S. Preventive Services Task Force, and services provided under fully capitated arrangements. The bill defines key terms like "intervention-necessary care" as health services that, if not provided, would risk serious harm to a patient's health. HMOs and insurers are restricted from denying payment for these services unless the physician knowingly misrepresents the service or fails to substantially perform it. The bill also limits retrospective reviews of these services, allowing them only when there is reasonable cause to suspect potential denial. Healthcare providers who submit preauthorization requests for services that do not require such requests must receive a written notice from the insurer explaining that preauthorization is not needed. The new regulations will apply to health benefit plans delivered or renewed on or after January 1, 2026, and the act will take effect on September 1, 2025.

Business and Industry, Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB1380