House Bill No. 2641 introduces a new subchapter to the Texas Insurance Code, specifically addressing preauthorization requirements for health benefit plans. The bill prohibits health maintenance organizations and insurers from requiring preauthorization for various health care services, including emergency care, intervention-necessary care, primary care, outpatient mental health treatment, and certain cancer treatments, among others. Additionally, it establishes that preauthorization requests for chronic health conditions do not expire unless the standard treatment changes. The bill also outlines the definitions of key terms such as "chronic health condition," "emergency care," and "preauthorization."

Furthermore, the bill stipulates that health maintenance organizations or 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. It also restricts retrospective reviews of such services unless there is reasonable cause to suspect a basis for denial. 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.

Statutes affected:
Introduced: ()