bill requiring reviewer details on preauthorization decisions

The text as introduced · 344 words

89R5925 DNC-F

By: Campbell
S.B. No. 2012

A BILL TO BE ENTITLED

AN ACT

relating to the provision of certain information about physicians

and nurses making determinations regarding requests for

preauthorization of health care services or supplies.

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

SECTION 1. Subchapter G, Chapter 4201, Insurance Code, is

amended by adding Section 4201.3025 to read as follows:

Sec. 4201.3025. PREAUTHORIZATION DETERMINATION: REQUIRED

PHYSICIAN INFORMATION. A utilization review agent shall include in

any written documentation that records a utilization review

determination made regarding a request for preauthorization, as

defined by Section 4201.651, or a determination made in an appeal of

an adverse determination made regarding a request for

preauthorization:

(1) the signature of the physician or nurse making the

determination;

(2) the full printed name of the physician or nurse;

(3) a unique provider identifier number for the

physician or nurse, such as a national provider identifier;

(4) the credentials of the physician or nurse,

including board certification and area of specialty expertise and

training, as applicable;

(5) attestation by the physician or nurse that the

physician or nurse has appropriate training and expertise in the

field of medicine that is sufficient to make an informed decision

regarding the medical necessity or appropriateness of the health

care service or supply proposed to be provided to the patient;

(6) attestation by the physician or nurse that the

physician or nurse does not have a conflict of interest that would

interfere with the physician's or nurse's ability to make an

impartial determination based on the merits of the specific patient

case; and

(7) the amount of time the physician or nurse spent

evaluating medical records or other information related to the

review or appeal before making the determination.

SECTION 2. Section 4201.3025, Insurance Code, as added by

this Act, applies only to a request for preauthorization made on or

after January 1, 2026, under a health benefit plan delivered,

issued for delivery, or renewed on or after that date.

SECTION 3. This Act takes effect September 1, 2025.