HB 2320

relating to specialist referrals by primary care providers for
certain managed care health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Subtitle C, Title 8, Insurance Code, is amended
by adding Chapter 1276 to read as follows:
CHAPTER 1276.  REFERRAL REQUIREMENTS
Sec. 1276.001.  APPLICABILITY OF CHAPTER.  (a)  This chapter
applies only to a health benefit plan, including a plan provided by
a health maintenance organization operating under Chapter 843, that
requires a primary care physician or other participating health
care provider to provide a referral to an enrollee as a condition of
payment or for the enrollee to receive a network benefit.
(b)  Notwithstanding any other law, this chapter applies to:
(1)  a basic coverage plan under Chapter 1551;
(2)  a basic plan under Chapter 1575; and
(3)  a primary care coverage plan under Chapter 1579.
Sec. 1276.002.  EXCEPTION.  This chapter does not apply to a
Medicaid managed care program operated under Chapter 540,
Sec. 1276.003.  SPECIALIST REFERRALS.  (a)  An issuer or
administrator of a managed care plan that requires an enrollee to
obtain a referral from a primary care provider before receiving
health care services from a specialist shall accept a referral from
(1)  the enrollee has had at least one visit with the
provider before the provider made the referral; and
(2)  the referral is for treatment of a chronic or
(b)  Notwithstanding Subsection (a), a managed care plan
issuer or administrator may refuse to accept a referral from a
primary care provider for specialist services if:
(1)  more than three years have passed since the
(2)  the provider has withdrawn the referral;
(3)  the enrollee's primary care provider has changed
since the referral was made; or
(4)  the enrollee's managed care plan issuer or
administrator has changed since the referral was made.
SECTION 2.  The changes in law made by this Act apply only to
a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2026.
SECTION 3.  This Act takes effect September 1, 2025.