HB2150 - Relating to telephone access for certain health benefit plan verifications and preauthorization requests and for utilization review requests.

  89R2727 RDS-F     By: Garcia Hernandez H.B. No. 2150       A BILL TO BE ENTITLED   AN ACT   relating to telephone access for certain health benefit plan   verifications and preauthorization requests and for utilization   review requests.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 843.347(c), Insurance Code, is amended   to read as follows:          (c)  A health maintenance organization shall have   appropriate personnel reasonably available at a toll-free   telephone number to provide a verification under this section 24   hours a day, seven days a week, including [ between 6 a.m. and 6 p.m.   central time Monday through Friday on each day that is not a legal   holiday and between 9 a.m. and noon central time on Saturday,   Sunday, and ] legal holidays. A health maintenance organization   must :                 (1)   have a telephone system capable of accepting or   recording incoming phone calls for verifications during any period   in which personnel are not available due to circumstances beyond   the health maintenance organization's reasonable control; [ after 6   p.m. central time Monday through Friday and after noon central time   on Saturday, Sunday, and legal holidays ] and                 (2)  respond [ responding ] to each of those calls as   soon as possible but not later than two hours after [ on or before   the second calendar day after the date ] the call is received.          SECTION 2.  Section 843.348(f), Insurance Code, is amended   to read as follows:          (f)  A health maintenance organization shall have   appropriate personnel reasonably available at a toll-free   telephone number to respond to requests for a preauthorization 24   hours a day, seven days a week, including [ between 6 a.m. and 6 p.m.   central time Monday through Friday on each day that is not a legal   holiday and between 9 a.m. and noon central time on Saturday,   Sunday, and ] legal holidays. A health maintenance organization   must :                 (1)   have a telephone system capable of accepting or   recording incoming phone calls for preauthorizations during any   period in which personnel are not available due to circumstances   beyond the health maintenance organization's reasonable control;   [ after 6 p.m. central time Monday through Friday and after noon   central time on Saturday, Sunday, and legal holidays ] and                 (2)  respond [ responding ] to each of those calls as   soon as possible but not later than two [ 24 ] hours after the call is   received.          SECTION 3.  Section 1301.133(c), Insurance Code, is amended   to read as follows:          (c)  An insurer shall have appropriate personnel reasonably   available at a toll-free telephone number to provide a verification   under this section 24 hours a day, seven days a week, including   [ between 6 a.m. and 6 p.m. central time Monday through Friday on   each day that is not a legal holiday and between 9 a.m. and noon   central time on Saturday, Sunday, and ] legal holidays. An insurer   must :                 (1)   have a telephone system capable of accepting or   recording incoming phone calls for verifications during any period   in which personnel are not available due to circumstances beyond   the insurer's reasonable control; [ after 6 p.m. central time Monday   through Friday and after noon central time on Saturday, Sunday, and   legal holidays ] and                 (2)  respond [ responding ] to each of those calls as   soon as possible but not later than two hours after [ on or before   the second calendar day after the date ] the call is received.          SECTION 4.  Section 1301.135(e), Insurance Code, is amended   to read as follows:          (e)  An insurer shall have appropriate personnel reasonably   available at a toll-free telephone number to respond to requests   for a preauthorization 24 hours a day, seven days a week, including     [ between 6 a.m. and 6 p.m. central time Monday through Friday on   each day that is not a legal holiday and between 9 a.m. and noon   central time on Saturday, Sunday, and ] legal holidays. An insurer   must :                 (1)   have a telephone system capable of accepting or   recording incoming phone calls for preauthorizations during any   period in which personnel are not available due to circumstances   beyond the insurer's reasonable control; [ after 6 p.m. central time   Monday through Friday and after noon central time on Saturday,   Sunday, and legal holidays ] and                 (2)  respond [ responding ] to each of those calls as   soon as possible but not later than two [ 24 ] hours after the call is   received.          SECTION 5.  Section 4201.004(a), Insurance Code, is amended   to read as follows:          (a)  A utilization review agent shall:                (1)  have appropriate personnel reasonably available,   by toll-free telephone 24 hours a day, seven days a week, including   legal holidays [ at least 40 hours per week during normal business   hours in this state ], to discuss patients' care and allow response   to telephone review requests;                (2)  have a telephone system capable, during any period   in which personnel are not available due to circumstances beyond   the utilization review agent's reasonable control [ hours other than   normal business hours ], of accepting or recording incoming   telephone calls or of providing instructions to a caller; and                (3)  respond to a call made during a period described by   Subdivision (2) as soon as possible but [ hours other than normal   business hours ] not later than two hours [ the second working day ]   after the call is received [ later of:                      [ (A) the date the call was received; or                      [ (B) the date the details necessary to respond   have been received from the caller ].          SECTION 6.  This Act takes effect September 1, 2025.