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 bill adds that this definition applies "regardless of the final diagnosis of the conditions," and outlines specific criteria that a prudent layperson with average medical knowledge would consider indicative of a need for immediate medical care, such as serious jeopardy to health or serious impairment of bodily functions.

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 apply only to 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 843, Insurance Code 4201, Insurance Code 1301)