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 conditions, emphasizing that the perception of urgency should be based on what a prudent layperson with average medical knowledge would believe regarding the potential risks of not receiving immediate care.

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 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 1301, Insurance Code 4201, Insurance Code 843)