S.B. No. 1380 introduces a new subchapter to Chapter 4201 of the Texas Insurance Code, focusing on preauthorization requirements for participating physicians and providers delivering specific health care services. The bill defines key terms such as "health care services," "intervention-necessary care," "physician," "preauthorization," and "provider." It establishes that the subchapter applies to health benefit plans offered by health maintenance organizations and certain insurer plans, while explicitly excluding the child health plan program, state Medicaid program, and other specified services.

The bill prohibits health maintenance organizations and insurers from requiring preauthorization for various health care services, including emergency care, intervention-necessary care, outpatient mental health treatment, and preventive services recommended by the U.S. Preventive Services Task Force. It also outlines the conditions under which payment cannot be denied or reduced for services not requiring preauthorization, emphasizing that retrospective reviews can only occur under specific circumstances. The provisions of this subchapter will take effect for preauthorization requests made on or after January 1, 2026, with the overall act becoming effective on September 1, 2025.

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