Bill Caption

Relating to preauthorization requirements for certain medical and health care services and utilization review for certain health benefit plans.

Fiscal Notes

No significant fiscal implication to the State is anticipated.

Bill Analysis

HB 3459 would prohibit a health maintenance organization or insurer from requiring a physician or provider to obtain preauthorization for a particular health care service if, in the preceding calendar year the physician or provider submitted 5 or more preauthorization requests for the particular health care service and at least 80% of the preauthorization requests for the particular health service were approved.

The bill would also require a health maintenance organization or insurer to provide notice to a physician or provider that they qualify for the aforementioned exemption from preauthorization, which services the exemption applies to, and that the exemption lasts for one year.

Vote Recommendation Notes

Texas Action opposes HB 3459 because it violates the limited government principle. The state should not insert itself into these decisions by managing the way insurers handle preauthorization.