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 a prior authorization request within three calendar days of receiving the request. Similarly, Section 1305.353(d) of the Insurance Code is updated to require that determinations be issued within three calendar days as well.

Additionally, the bill introduces a new section, 4201.3045, to the Insurance Code, which mandates that utilization review agents must transmit notice of their determinations regarding preauthorization requests within three calendar days. The bill also includes provisions that specify the applicability of these changes based on the effective date of contracts and policies, ensuring that requests under existing contracts are governed by the previous law. The act is set to take effect on September 1, 2025.

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