The bill, H.B. No. 2641, introduces a new subchapter to the Texas Insurance Code that prohibits health maintenance organizations and insurers from requiring preauthorization for certain health care services provided by physicians and providers. Specifically, the bill outlines a list of services that are exempt from preauthorization, including emergency care, intervention-necessary care, primary care, outpatient mental health treatment, antineoplastic cancer treatments, and various other specified health care services. Additionally, it establishes that an approved preauthorization request for a chronic health condition remains valid unless the standard treatment for that condition changes.

The bill also stipulates that health maintenance organizations and insurers cannot deny or reduce payment for services that do not require preauthorization unless there is evidence of misrepresentation or failure to perform the service. Furthermore, it restricts retrospective reviews of such services unless there is reasonable cause to suspect a basis for denial. The provisions of this bill will apply to health benefit plans delivered or renewed on or after January 1, 2026, and the act is set to take effect on September 1, 2025.

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