Miles’s bill bars preauthorization for mandated screenings

The text as introduced · 770 words

89R419 CJD-F

By: Miles
S.B. No. 1142

A BILL TO BE ENTITLED

AN ACT

relating to preauthorization of certain benefits by certain health

benefit plan issuers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1356.005, Insurance Code, is amended by

adding Subsection (c) to read as follows:

(c) A health benefit plan issuer that provides coverage

under this section may not require preauthorization for a screening

mammogram or diagnostic imaging described by Subsection (a) or

(a-1). This subsection may not be construed to authorize a

physician or other health care provider to provide the medical care

or health care described by this section if providing the care is

outside of the scope of the individual's applicable license or

other authorization issued under Title 3, Occupations Code.

SECTION 2. Section 1357.004, Insurance Code, is amended by

adding Subsection (c) to read as follows:

(c) A health benefit plan issuer that provides coverage

under this section may not require preauthorization for a

reconstruction, surgery, prostheses, or treatment described by

Subsection (a). This subsection may not be construed to authorize a

physician or other health care provider to provide the medical care

or health care described by this section if providing the care is

outside of the scope of the individual's applicable license or

other authorization issued under Title 3, Occupations Code.

SECTION 3. Section 1357.054, Insurance Code, is amended by

adding Subsection (c) to read as follows:

(c) A health benefit plan issuer that provides coverage

under this section may not require preauthorization for inpatient

care described by Subsection (a). This subsection may not be

construed to authorize a physician or other health care provider to

provide the medical care or health care described by this section if

providing the care is outside of the scope of the individual's

applicable license or other authorization issued under Title 3,

Occupations Code.

SECTION 4. Section 1358.054, Insurance Code, is amended by

adding Subsection (c) to read as follows:

(c) A health benefit plan issuer that provides coverage

under this section may not require preauthorization for the

provision to a qualified enrollee of diabetes equipment, diabetes

supplies, or diabetes self-management training described by

Subsection (a). This subsection may not be construed to authorize a

physician or other health care provider to provide the medical care

or health care described by this section if providing the care is

outside of the scope of the individual's applicable license or

other authorization issued under Title 3, Occupations Code.

SECTION 5. Section 1361.003, Insurance Code, is amended to

read as follows:

Sec. 1361.003. COVERAGE REQUIRED. (a) A group health

benefit plan must provide to a qualified enrollee coverage for

medically accepted bone mass measurement to detect low bone mass

and to determine the enrollee's risk of osteoporosis and fractures

associated with osteoporosis.

(b) A group health benefit plan issuer that provides

coverage under this section may not require preauthorization for

the provision to a qualified enrollee of a bone mass measurement

described by Subsection (a). This subsection may not be construed

to authorize a physician or other health care provider to provide

the medical care or health care described by this section if

providing the care is outside of the scope of the individual's

applicable license or other authorization issued under Title 3,

Occupations Code.

SECTION 6. Section 1362.003, Insurance Code, is amended by

adding Subsection (c) to read as follows:

(c) A health benefit plan issuer that provides coverage

under this section to an enrolled male may not require

preauthorization for a diagnostic examination described by

Subsection (a). This subsection may not be construed to authorize a

physician or other health care provider to provide the medical care

or health care described by this section if providing the care is

outside of the scope of the individual's applicable license or

other authorization issued under Title 3, Occupations Code.

SECTION 7. Section 1363.003, Insurance Code, is amended by

adding Subsection (d) to read as follows:

(d) A health benefit plan issuer that provides coverage

under this section may not require preauthorization for a screening

examination described by Subsection (a). This subsection may not

be construed to authorize a physician or other health care provider

to provide the medical care or health care described by this section

if providing the care is outside of the scope of the individual's

applicable license or other authorization issued under Title 3,

Occupations Code.

SECTION 8. This Act applies only to a health benefit plan

that is delivered, issued for delivery, or renewed on or after

January 1, 2026.

SECTION 9. This Act takes effect September 1, 2025.