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  89R4361 SCF-F     By: Vo H.B. No. 1818       A BILL TO BE ENTITLED   AN ACT   relating to examinations of health maintenance organizations and   insurers by the commissioner of insurance regarding compliance with   certain utilization review and preauthorization requirements;   authorizing a fee.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 843.154(f), Insurance Code, is amended   to read as follows:          (f)  A health maintenance organization shall pay to the   commissioner a fee in an amount assessed by the commissioner and   paid in accordance with rules adopted by the commissioner for the   expenses of an examination under Section 843.156(a) or (a-1) that:                (1)  are incurred by the commissioner or under the   commissioner's authority; and                (2)  are directly attributable to that examination,   including the actual salaries and expenses of the examiners   directly attributable to that examination, as determined under   rules adopted by the commissioner.          SECTION 2.  Section 843.156, Insurance Code, is amended by   adding Subsections (a-1) and (a-2) to read as follows:           (a-1)     The commissioner shall examine a health maintenance   organization to determine the health maintenance organization's   compliance with applicable requirements related to utilization   review, including requirements under this chapter, Chapter 1222,   Chapter 1369, and Chapter 4201 that relate to the preauthorization   of health care services. The commissioner may conduct an   examination under this subsection as often as the commissioner   considers necessary but shall conduct an examination at least once   annually.   Documentation provided to the commissioner during an   examination conducted under this subsection is confidential and is   not subject to disclosure as public information under Chapter 552,   Government Code.   In this subsection and Subsection (a-2),   "utilization review" has the meaning assigned by Section 4201.002.           (a-2)     If in a certain year the commissioner examines or will   examine a health maintenance organization's compliance with   applicable requirements related to utilization review as part of an   examination other than the examination required by Subsection   (a-1), the commissioner is not required to examine the health   maintenance organization under Subsection (a-1) in that year.          SECTION 3.  Section 1301.0056, Insurance Code, is amended by   adding Subsections (a-2) and (a-3) to read as follows:           (a-2)     The commissioner shall examine an insurer to   determine the insurer's compliance with applicable requirements   related to utilization review, including requirements under this   chapter, Chapter 1222, Chapter 1369, and Chapter 4201 that relate   to the preauthorization of medical care or health care services.     The commissioner may conduct an examination under this subsection   as often as the commissioner considers necessary but shall conduct   an examination at least once annually.   In this subsection and   Subsection (a-3), "utilization review" has the meaning assigned by   Section 4201.002.           (a-3)     If in a certain year the commissioner examines or will   examine an insurer's compliance with applicable requirements   related to utilization review as part of an examination other than   the examination required by Subsection (a-2), the commissioner is   not required to examine the insurer under Subsection (a-2) in that   year.          SECTION 4.  This Act takes effect September 1, 2025.