bill cutting preauthorization answers to three calendar days

The text as introduced · 658 words

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.