S.B. No. 1380 introduces a new subchapter to the Texas Insurance Code that establishes preauthorization requirements for participating physicians and providers offering specific health care services. The bill defines key terms such as "health care services," "intervention-necessary care," "physician," "preauthorization," and "provider." It specifies that the new regulations apply to health benefit plans offered by health maintenance organizations and certain insurer plans, while explicitly excluding programs like the child health plan and state Medicaid.

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 may not be denied or reduced for services that do not require preauthorization. The provisions of this subchapter will take effect for requests made under health benefit plans delivered or renewed on or after January 1, 2026, with the overall act becoming effective on September 1, 2025.

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