The bill, S.B. No. 1380, introduces a new subchapter to Chapter 4201 of the Texas Insurance Code, specifically addressing preauthorization requirements for health benefit plans. It prohibits health maintenance organizations and insurers from requiring preauthorization for certain health care services, including emergency care, intervention-necessary care, primary care, outpatient mental health treatment, and specific cancer treatments, among others. The bill also stipulates that an approved preauthorization request for a chronic health condition remains valid unless the standard treatment for that condition changes.

Additionally, the bill outlines the conditions under which a health maintenance organization or insurer may not deny or reduce payment for services that do not require preauthorization. It establishes that retrospective reviews of such services can only occur if there is reasonable cause to suspect a basis for denial. The provisions of this subchapter will apply to preauthorization requests made under 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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