The bill amends existing laws regarding the timeframes for responding to requests for preauthorization of health benefits in Texas. Specifically, it changes the response time from "business days" to "calendar days" for Medicaid managed care organizations and insurance companies. Under the amended Section 540.0303(b) of the Government Code, organizations must now issue a determination on prior authorization requests within three calendar days of receiving the request. Similarly, Section 1305.353(d) of the Insurance Code is updated to require that determinations for certain services be issued within three calendar days as well, removing the previous reference to "working days."

Additionally, the bill introduces a new section, 4201.3045, to the Insurance Code, which mandates that utilization review agents must provide notice of determinations regarding preauthorization requests within three calendar days or as specified by other applicable laws. The bill also includes provisions for the implementation of these changes, stating that they will apply only to contracts entered into or renewed after the effective date of the Act, which is set for September 1, 2025. This ensures that existing contracts are governed by the previous laws until their renewal or expiration.

Statutes affected:
Introduced: Insurance Code 1305.353 (Insurance Code 1305)