The bill amends the Texas Insurance Code by adding Chapter 1276, which establishes new requirements for specialist referrals by primary care providers within certain managed care health benefit plans. Specifically, it mandates that managed care plans requiring referrals must accept them if the enrollee has had at least one prior visit with the provider and the referral is for a chronic or ongoing condition. However, the bill also allows managed care issuers or administrators to refuse referrals under specific circumstances, such as if more than three years have passed since the referral was made or if there have been changes in the enrollee's primary care provider or managed care plan issuer.

Additionally, the bill clarifies that it applies only to health benefit plans that require referrals for payment or network benefits, excluding Medicaid managed care programs. The provisions of this act will take effect on September 1, 2025, and will apply to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2026.

Statutes affected:
Introduced: ()