HB3127 - Relating to the time for providing a response to a request for preauthorization of health benefits.

  89R6189 SCF-D     By: Bhojani H.B. No. 3127       A BILL TO BE ENTITLED   AN ACT   relating to the time for providing a response to a request for   preauthorization of health benefits.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 540.0303(b), Government Code, as   effective April 1, 2025, is amended to read as follows:          (b)  In addition to the requirements of Subchapter F, a   contract between a Medicaid managed care organization and the   commission to which that subchapter applies must require that the   organization review and issue a determination on a prior   authorization request to which this section applies according to   the following time frames:                (1)  within three calendar [ business ] days after the   organization receives the request; or                (2)  within the time frame and following the process   the commission establishes if the organization receives a prior   authorization request that does not include sufficient or adequate   documentation.          SECTION 2.  Section 1305.353(d), Insurance Code, is amended   to read as follows:          (d)  For services not described under Subsection (e) or (f),   the determination under Subsection (c) must be issued and   transmitted not later than the third calendar [ working ] day after   the date the request is received. [ For the purposes of this   subsection, "working day" has the meaning assigned by Section   4201.002. ]          SECTION 3.  Subchapter G, Chapter 4201, Insurance Code, is   amended by adding Section 4201.3045 to read as follows:           Sec.   4201.3045.     TIME FOR NOTICE REGARDING PREAUTHORIZATION   REQUEST. (a)   In this section, "preauthorization" means a   determination that health care services proposed to be provided to   a patient are medically necessary and appropriate.           (b)     A utilization review agent must transmit notice of a   determination made in a utilization review of a preauthorization   request not later than the earlier of:                 (1)     the time by which the notice must be provided under   another provision of this subchapter or other applicable law; or                 (2)     the third calendar day after the date of the   preauthorization request.          SECTION 4.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 5.  (a) Section 540.0303(b), Government Code, as   amended by this Act, applies only to a preauthorization request   under a contract entered into on or after the effective date of this   Act. A preauthorization request under a contract entered into   before the effective date of this Act 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.          (b)  Section 1305.353(d), Insurance Code, as amended by this   Act, applies only to a preauthorization request under a workers'   compensation health care network contract entered into or renewed   on or after the effective date of this Act.  A preauthorization   request under a workers' compensation health care network contract   entered into or renewed before the effective date of this Act 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.          (c)  Section 4201.3045, Insurance Code, as added by this Act,   applies only to a preauthorization request under a health insurance   policy or health benefit plan delivered, issued for delivery, or   renewed on or after January 1, 2026, or for which the plan year   commences on or after January 1, 2026.  A preauthorization request   under a health insurance policy or health benefit plan delivered,   issued for delivery, or renewed before January 1, 2026, or for which   the plan year commenced 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 6.  This Act takes effect September 1, 2025.