The bill, H.B. No. 2641, introduces a new subchapter (Subchapter O) to Chapter 4201 of the Texas Insurance Code, which establishes prohibited preauthorization requirements for physicians and providers delivering specific health care services. The bill defines key terms such as "chronic health condition," "emergency care," and "intervention-necessary care," and specifies that health maintenance organizations (HMOs) or insurers cannot require preauthorization for various services, including emergency care, primary care, outpatient mental health treatment, and certain cancer treatments, among others. Additionally, it stipulates that an approved preauthorization request for a chronic health condition remains valid unless the standard treatment changes.

Furthermore, the bill outlines the conditions under which HMOs or insurers may not deny or reduce payments for services that do not require preauthorization, emphasizing that such actions can only occur if there is evidence of misrepresentation or failure to perform the service. It also mandates that if a preauthorization request is submitted for a service that does not require it, the HMO or insurer must provide written notice to the provider. The provisions of this subchapter 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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