Bill > HB3812

This bill modifies Texas insurance law regarding health benefit plan preauthorization requirements and utilization review by physicians. The bill extends the evaluation period for preauthorization exemptions from six months to one year, requiring health maintenance organizations and insurers to grant exemptions to physicians or providers who have approved at least 90% of their preauthorization requests and have performed a particular health care service at least five times during the evaluation period. The bill mandates that the physician conducting utilization review cannot hold an administrative medicine license, and requires health maintenance organizations and insurers to include all preauthorization requests across their affiliates and policies when evaluating exemption eligibility. Additionally, the bill introduces new reporting requirements, compelling insurers to submit annual reports to the state department detailing exemptions, denials, and independent review outcomes, while ensuring that any published reports protect individual identifying information. The bill also establishes more detailed procedures for rescinding preauthorization exemptions, including specific notification requirements and provisions for reviewing claims when few claims are submitted. These changes aim to provide more transparency and fairness in the preauthorization process for healthcare providers.

Business and Industry, Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB3812