H.B. No. 3812 amends the Texas Insurance Code to modify preauthorization requirements for health benefit plans, particularly focusing on the utilization review process directed by physicians. The bill stipulates that a utilization review agent must conduct reviews under the direction of a licensed physician, who cannot hold a license to practice administrative medicine. Additionally, the definition of "preauthorization" is clarified, and the evaluation period for determining whether a physician or provider must obtain preauthorization is extended from six months to one year. The bill also introduces new criteria for exemption from preauthorization, requiring that at least 90% of requests be approved during the evaluation period, and mandates that all preauthorization requests be considered, regardless of the specific health insurance policy involved.

Further provisions include the requirement for health maintenance organizations and insurers to conduct evaluations annually rather than biannually, and to notify providers of any rescission of exemptions with adequate time for appeal. The bill also establishes a new reporting requirement for health maintenance organizations and insurers to submit annual reports detailing exemptions granted, rescinded, or denied, as well as outcomes of independent reviews. The changes are set to take effect on September 1, 2025, and any preauthorization exemptions granted prior to this date cannot be rescinded until at least one year after the last evaluation period.

Statutes affected:
Introduced: Insurance Code 4201.152, Subchapter M, Chapter , Insurance Code 155.009, Insurance Code 4201.602, Insurance Code 4201.603, Insurance Code 4201.651, Insurance Code 4201.653, Insurance Code 4201.655, Insurance Code 4201.656, Insurance Code 4201.658, Insurance Code 4201.659, Occupations Code 151.002 (Subchapter M, Chapter , Insurance Code 155, Occupations Code 151, Insurance Code 4201)
House Committee Report: Insurance Code 4201.152, Insurance Code 4201.651, Insurance Code 4201.653, Insurance Code 4201.655, Insurance Code 4201.656, Insurance Code 4201.658, Insurance Code 4201.659 (Subchapter M, Chapter , Insurance Code 155, Occupations Code 151, Insurance Code 4201)
Engrossed: Insurance Code 4201.152, Insurance Code 4201.651, Insurance Code 4201.653, Insurance Code 4201.655, Insurance Code 4201.656, Insurance Code 4201.658, Insurance Code 4201.659 (Subchapter M, Chapter , Insurance Code 155, Occupations Code 151, Insurance Code 4201)
Senate Committee Report: Insurance Code 4201.152, Insurance Code 4201.651, Insurance Code 4201.653, Insurance Code 4201.655, Insurance Code 4201.656, Insurance Code 4201.658, Insurance Code 4201.659 (Subchapter M, Chapter , Insurance Code 155, Occupations Code 151, Insurance Code 4201)
Enrolled: Insurance Code 4201.152, Insurance Code 4201.651, Insurance Code 4201.653, Insurance Code 4201.655, Insurance Code 4201.656, Insurance Code 4201.658, Insurance Code 4201.659 (Subchapter M, Chapter , Insurance Code 155, Occupations Code 151, Insurance Code 4201)