HB 1818

relating to examinations of health maintenance organizations and
insurers by the commissioner of insurance regarding compliance with
certain utilization review and preauthorization requirements;
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Section 843.154(f), Insurance Code, is amended
(f)  A health maintenance organization shall pay to the
commissioner a fee in an amount assessed by the commissioner and
paid in accordance with rules adopted by the commissioner for the
expenses of an examination under Section 843.156(a) or (a-1) that:
(1)  are incurred by the commissioner or under the
(2)  are directly attributable to that examination,
including the actual salaries and expenses of the examiners
directly attributable to that examination, as determined under
rules adopted by the commissioner.
SECTION 2.  Section 843.156, Insurance Code, is amended by
adding Subsections (a-1) and (a-2) to read as follows:
(a-1)  The commissioner shall examine a health maintenance
organization to determine the health maintenance organization's
compliance with applicable requirements related to utilization
review, including requirements under this chapter, Chapter 1222,
Chapter 1369, and Chapter 4201 that relate to the preauthorization
of health care services. The commissioner may conduct an
examination under this subsection as often as the commissioner
considers necessary but shall conduct an examination at least once
annually.  Documentation provided to the commissioner during an
examination conducted under this subsection is confidential and is
not subject to disclosure as public information under Chapter 552,
Government Code.  In this subsection and Subsection (a-2),
"utilization review" has the meaning assigned by Section 4201.002.
(a-2)  If in a certain year the commissioner examines or will
examine a health maintenance organization's compliance with
applicable requirements related to utilization review as part of an
examination other than the examination required by Subsection
(a-1), the commissioner is not required to examine the health
maintenance organization under Subsection (a-1) in that year.
SECTION 3.  Section 1301.0056, Insurance Code, is amended by
adding Subsections (a-2) and (a-3) to read as follows:
(a-2)  The commissioner shall examine an insurer to
determine the insurer's compliance with applicable requirements
related to utilization review, including requirements under this
chapter, Chapter 1222, Chapter 1369, and Chapter 4201 that relate
to the preauthorization of medical care or health care services.
The commissioner may conduct an examination under this subsection
as often as the commissioner considers necessary but shall conduct
an examination at least once annually.  In this subsection and
Subsection (a-3), "utilization review" has the meaning assigned by
(a-3)  If in a certain year the commissioner examines or will
examine an insurer's compliance with applicable requirements
related to utilization review as part of an examination other than
the examination required by Subsection (a-2), the commissioner is
not required to examine the insurer under Subsection (a-2) in that
SECTION 4.  This Act takes effect September 1, 2025.