HB1635 - Relating to the definition of emergency care for purposes of certain health benefit plans.

  89R1176 RDS-F     By: Oliverson H.B. No. 1635       A BILL TO BE ENTITLED   AN ACT   relating to the definition of emergency care for purposes of   certain health benefit plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 843.002(7), Insurance Code, is amended   to read as follows:                (7)  "Emergency care" means health care services   provided in a hospital emergency facility, freestanding emergency   medical care facility, or comparable emergency facility to evaluate   and stabilize medical conditions of a recent onset and severity,   including severe pain, regardless of the final diagnosis of the   conditions, that would lead a prudent layperson possessing an   average knowledge of medicine and health to believe that the   individual's condition, sickness, or injury is of such a nature   that failure to get immediate medical care could:                      (A)  place the individual's health in serious   jeopardy;                      (B)  result in serious impairment to bodily   functions;                      (C)  result in serious dysfunction of a bodily   organ or part;                      (D)  result in serious disfigurement; or                      (E)  for a pregnant woman, result in serious   jeopardy to the health of the fetus.          SECTION 2.  Section 1301.155(a), Insurance Code, is amended   to read as follows:          (a)  In this section, "emergency care" means health care   services provided in a hospital emergency facility, freestanding   emergency medical care facility, or comparable emergency facility   to evaluate and stabilize a medical condition of a recent onset and   severity, including severe pain, regardless of the final diagnosis   of the condition, that would lead a prudent layperson possessing an   average knowledge of medicine and health to believe that the   person's condition, sickness, or injury is of such a nature that   failure to get immediate medical care could result in:                (1)  placing the person's health in serious jeopardy;                (2)  serious impairment to bodily functions;                (3)  serious dysfunction of a bodily organ or part;                (4)  serious disfigurement; or                (5)  in the case of a pregnant woman, serious jeopardy   to the health of the fetus.          SECTION 3.  Sections 4201.002(2) and (13), Insurance Code,   are amended to read as follows:                (2)  "Emergency care" means health care services   provided in a hospital emergency facility or comparable facility to   evaluate and stabilize medical conditions of a recent onset and   severity, including severe pain, regardless of the final diagnosis   of the conditions, that would lead a prudent layperson possessing   an average knowledge of medicine and health to believe that the   individual's condition, sickness, or injury is of such a nature   that failure to get immediate medical care could:                      (A)  place the individual's health in serious   jeopardy;                      (B)  result in serious impairment to bodily   functions;                      (C)  result in serious dysfunction of a bodily   organ or part;                      (D)  result in serious disfigurement; or                      (E)  for a pregnant woman, result in serious   jeopardy to the health of the fetus.                (13)  "Utilization review" includes a system for   prospective, concurrent, or retrospective review of the medical   necessity and appropriateness of health care services , including a   determination that the services do not meet the definition of   emergency care, and a system for prospective, concurrent, or   retrospective review to determine the experimental or   investigational nature of health care services. The term does not   include a review in response to an elective request for   clarification of coverage.          SECTION 4.  The changes in law made by this Act apply only to   a health benefit plan delivered, issued for delivery, or renewed on   or after January 1, 2026. A health benefit plan delivered, issued   for delivery, or renewed before January 1, 2026, is governed by the   law as it existed immediately before the effective date of this Act,   and that law is continued in effect for that purpose.          SECTION 5.  This Act takes effect September 1, 2025.