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

The text as introduced · 921 words

90R4138 RDS-F

By: Garcia Hernandez
H.B. No. 469

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, 2027.