85R13312 BEE-D     By: Shaheen H.B. No. 3412       A BILL TO BE ENTITLED   AN ACT   relating to preauthorization by certain health benefit plan issuers   of certain covered benefits under the health benefit plan.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter I, Chapter 843, Insurance Code, is   amended by adding Section 843.324 to read as follows:          Sec. 843.324.  PREAUTHORIZATION OF CERTAIN COVERED   BENEFITS; WAIVER. (a) The commissioner by rule shall:                (1)  specify covered benefits provided to an enrollee   under a health care plan for which the health maintenance   organization is prohibited from requiring a physician or provider   to obtain preauthorization from the health maintenance   organization in order for the health maintenance organization to   pay for the benefit; and                (2)  establish a simple procedure under which a   physician or provider may obtain a waiver of a health maintenance   organization's preauthorization requirement for a covered benefit   under circumstances specified by rule.          (b)  Rules adopted under Subsection (a) must provide that the   following covered benefits are not subject to preauthorization or   are subject to a waiver of preauthorization requirements:                (1)  if a physician or provider determines that an   enrollee has an immediate need for the covered benefit:                      (A)  durable medical equipment, including   crutches and wheelchairs; or                      (B)  diagnostic testing; or                 (2)  another health care service under circumstances   that take into account:                      (A)  symptoms displayed by the enrollee;                      (B)  the relationship between the physician or   provider and the enrollee, including the length of the   relationship; and                      (C)  the professional experience of the physician   or provider.          SECTION 2.  Subchapter B, Chapter 1301, Insurance Code, is   amended by adding Section 1301.070 to read as follows:          Sec. 1301.070.  PREAUTHORIZATION OF CERTAIN COVERED   BENEFITS; WAIVER. (a) The commissioner by rule shall:                (1)  specify covered benefits provided to an insured   under a preferred provider benefit plan for which the insurer is   prohibited from requiring a physician or health care provider to   obtain preauthorization from the insurer in order for the insurer   to pay for the benefit; and                (2)  establish a simple procedure under which a   physician or health care provider may obtain a waiver of an   insurer's preauthorization requirement for a covered benefit under   circumstances specified by rule.          (b)  Rules adopted under Subsection (a) must provide that the   following covered benefits are not subject to preauthorization or   are subject to a waiver of preauthorization requirements:                (1)  if a physician or health care provider determines   that an insured has an immediate need for the covered benefit:                      (A)  durable medical equipment, including   crutches and wheelchairs; or                      (B)  diagnostic testing; or                 (2)  another health care service under circumstances   that take into account:                      (A)  symptoms displayed by the insured;                      (B)  the relationship between the physician or   health care provider and the insured, including the length of the   relationship; and                      (C)  the professional experience of the physician   or health care provider.          SECTION 3.  The changes in law made by this Act apply only to   a health benefit plan delivered, issued for delivery, or renewed on   or after January 1, 2018. A health benefit plan delivered, issued   for delivery, or renewed before January 1, 2018, 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 4.  This Act takes effect September 1, 2017.