Bill Text: TX SB547 | 2025-2026 | 89th Legislature | Introduced
Bill Title: Relating to notice from a health benefit plan issuer to the Texas Department of Insurance regarding a physician's or health care provider's preauthorization exemption status.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-12-06 - Filed [SB547 Detail]
Download: Texas-2025-SB547-Introduced.html
| 89R4715 DNC-D | ||
| By: Menéndez | S.B. No. 547 | |
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| relating to notice from a health benefit plan issuer to the Texas | ||
| Department of Insurance regarding a physician's or health care | ||
| provider's preauthorization exemption status. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subchapter N, Chapter 4201, Insurance Code, is | ||
| amended by adding Section 4201.660 to read as follows: | ||
| Sec. 4201.660. EXEMPTION STATUS NOTIFICATION TO | ||
| DEPARTMENT; DATABASE AND REPORT. (a) A health maintenance | ||
| organization or insurer that uses a preauthorization process for | ||
| health care services shall provide written notice to the department | ||
| of a physician's or provider's preauthorization exemption status | ||
| under this subchapter not later than the 10th day after the date on | ||
| which the health maintenance organization or insurer: | ||
| (1) completes an evaluation of the physician or | ||
| provider as required by Section 4201.653(b) and determines whether | ||
| the physician or provider qualifies for an exemption; | ||
| (2) determines that the health maintenance | ||
| organization or insurer will continue the physician's or provider's | ||
| exemption under Section 4201.653(c); | ||
| (3) provides notice to the physician or provider of a | ||
| determination to rescind the physician's or provider's exemption; | ||
| or | ||
| (4) makes an internal appeal determination or receives | ||
| a determination from an independent review organization under | ||
| Section 4201.656 affirming or denying the health maintenance | ||
| organization's or insurer's determination to rescind the | ||
| physician's or provider's exemption. | ||
| (b) The department shall establish and maintain a database | ||
| of preauthorization exemption grants, denials, recissions, and | ||
| internal appeal and independent review determinations. On the | ||
| request of a physician or provider, the department shall provide | ||
| the physician or provider with information regarding the | ||
| physician's or provider's preauthorization exemption status with | ||
| respect to each relevant health maintenance organization or insurer | ||
| and with respect to each relevant health care service. | ||
| (c) The department shall collect and compile data | ||
| regarding: | ||
| (1) the number and timing of evaluations being | ||
| conducted by each health maintenance organization or insurer under | ||
| this subchapter; | ||
| (2) the number of internal appeals or independent | ||
| reviews conducted by or with respect to each health maintenance | ||
| organization or insurer under this subchapter; | ||
| (3) the number of exemptions granted, denied, or | ||
| rescinded by each health maintenance organization or insurer, by | ||
| provider type and health care service; and | ||
| (4) the number and outcomes of internal appeals or | ||
| independent reviews conducted by or with respect to each health | ||
| maintenance organization or insurer. | ||
| (d) The department shall annually prepare a statistical | ||
| report reflecting the data collected under Subsection (c) and make | ||
| the report available to the public on request. | ||
| SECTION 2. Section 4201.660, Insurance Code, as added by | ||
| this Act, applies only to a determination regarding a physician's | ||
| or provider's preauthorization exemption status made on or after | ||
| the effective date of this Act. | ||
| SECTION 3. This Act takes effect September 1, 2025. | ||
