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 certain health care services, including emergency care, intervention-necessary care, outpatient mental health treatment, and preventive services, cannot require preauthorization from health maintenance organizations or insurers. Additionally, it outlines the conditions under which payment cannot be denied or reduced for services that do not require preauthorization.

The bill also clarifies that it does not authorize physicians or providers to deliver services outside their licensed scope and does not obligate health maintenance organizations or insurers to pay for services performed in violation of state laws. The provisions of this subchapter will apply to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026, and the act is set to take effect on September 1, 2025.

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