Senate Bill 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 bill 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 bill adds that this definition applies "regardless of the final diagnosis" of the conditions, emphasizing that a prudent layperson with average medical knowledge would believe that immediate medical care is necessary to prevent serious health risks, such as jeopardy to health, impairment of bodily functions, dysfunction of organs, disfigurement, or risks to a fetus in pregnant women.

Additionally, the bill modifies the definition of "utilization review" to include a system for determining whether services meet the definition of emergency care. The changes in law will apply only 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 effective date for this Act is set for September 1, 2025.

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