House Bill No. 1635 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 definition now explicitly states that this applies "regardless of the final diagnosis" of the condition, emphasizing that the perception of a prudent layperson with average medical knowledge is key in determining the necessity for immediate care. The bill outlines specific scenarios that would qualify as emergencies, such as serious jeopardy to health, impairment of bodily functions, or risks to a fetus in the case of pregnant women.

Additionally, the bill modifies the definition of "utilization review" to include assessments of whether services meet the definition of emergency care. The changes will take effect for health benefit plans 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 act 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 4201, Insurance Code 843, Insurance Code 1301)