The bill, titled "Laboratory Claim Integrity Programs," introduces Chapter 1224 to the Texas Insurance Code, establishing regulations for laboratory claim integrity programs associated with health benefit plans. It defines key terms such as "clinical laboratory test," "enrollee," and "health benefit plan issuer," and mandates that any person providing such programs must register with the department, with registration valid for three years and subject to renewal. The bill outlines the requirements for these programs, emphasizing the need for objective, evidence-based reimbursement policies and the prohibition of certain practices, such as requiring clinical decision support software or disclosing an enrollee's protected health information without authorization.

Additionally, the bill specifies that actions taken by a laboratory claim integrity program, such as denying or reducing payment for claims that do not meet reimbursement policy requirements, do not constitute an adverse determination under Chapter 4201. The provisions of Chapter 1224 will apply to contracts entered into or renewed on or after January 1, 2026, and the act is set to take effect on September 1, 2025.

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