The bill, S.B. No. 622, amends the definition of "emergency care" within the Texas Insurance Code to clarify the circumstances under which health care services are considered emergency services. The new language specifies that emergency care includes services provided in various emergency facilities to evaluate and stabilize medical conditions of recent onset and severity, including severe pain. Notably, the definition now emphasizes that the assessment of whether care is deemed emergency care should be based on the perspective of a prudent layperson with average medical knowledge, regardless of the final diagnosis. This includes specific conditions that could jeopardize health or result in serious impairment or dysfunction.

Additionally, the bill modifies the definition of "utilization review" to include the determination of whether services meet the definition of emergency care. The changes will apply to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026, while plans renewed before this date will continue to be governed by the previous law. The bill is set to take effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 843.002, Insurance Code 1301.155, Insurance Code 4201.002 (Insurance Code 1301, Insurance Code 843, Insurance Code 4201)