TITLE: Relating to the telephone availability of certain personnel by certain health benefit plan issuers and utilization review agents.

SUMMARY: Relating to the telephone availability of certain personnel by certain health benefit plan issuers and utilization review agents.

FULL TEXT:
AN ACT relating to the telephone availability of certain personnel by certain health benefit plan issuers and utilization review agents. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Sections 843.347(c), Insurance Code, is amended to read as follows: (c) A health maintenance organization shall have appropriate personnel reasonably available at a toll-free telephone number to provide a verification under this section 24 hours a day, every day of the year, including on Saturdays, Sundays, and legal holidays [between 6 a.m. and 6 p.m. central time Monday through Friday on each day that is not a legal holiday and between 9 a.m. and noon central time on Saturday, Sunday, and legal holidays].A health maintenance organization must have a telephone system capable of accepting or recording incoming phone calls for verifications during times when personnel are not available due to circumstances beyond the health maintenance organization's reasonable control [after 6 p.m. central time Monday through Friday and after noon central time on Saturday, Sunday, and legal holidays] and respond [responding] to each of those calls as soon as possible and in no event later than two hours after the call [on or before the second calendar day after the date the call] is received. SECTION 2. Section 843.348(f), Insurance Code, is amended to read as follows: (f) A health maintenance organization shall have appropriate personnel reasonably available at a toll-free telephone number to respond to requests for a preauthorization 24 hours a day, every day of the year, including on Saturdays, Sundays, and legal holidays [between 6 a.m. and 6 p.m. central time Monday through Friday on each day that is not a legal holiday and between 9 a.m. and noon central time on Saturday, Sunday, and legal holidays].A health maintenance organization must have a telephone system capable of accepting or recording incoming phone calls for preauthorizations during times when personnel are not available due to circumstances beyond the health maintenance organization's reasonable control [after 6 p.m. central time Monday through Friday and after noon central time on Saturday, Sunday, and legal holidays] and respond [responding] to each of those calls as soon as possible and in no event [not] later than two [24] hours after the call is received. SECTION 3. Section 1301.133(c), Insurance Code, is amended to read as follows: (c) An insurer shall have appropriate personnel reasonably available at a toll-free telephone number to provide a verification under this section 24 hours a day, every day of the year, including on Saturdays, Sundays, and legal holidays [between 6 a.m. and 6 p.m. central time Monday through Friday on each day that is not a legal holiday and between 9 a.m. and noon central time on Saturday, Sunday, and legal holidays].An insurer must have a telephone system capable of accepting or recording incoming phone calls for verifications during times when personnel are not available due to circumstances beyond the insurer's reasonable control [after 6 p.m. central time Monday through Friday and after noon central time on Saturday, Sunday, and legal holidays] and respond [responding] to each of those calls as soon as possible and in no event later than two hours after [on or before the second calendar day after the date] the call is received. SECTION 4. Section 1301.135(e), Insurance Code, is amended to read as follows: (e) An insurer shall have appropriate personnel reasonably available at a toll-free telephone number to respond to requests for a preauthorization 24 hours a day, every day of the year, including on Saturdays, Sundays, and legal holidays [between 6 a.m. and 6 p.m. central time Monday through Friday on each day that is not a legal holiday and between 9 a.m. and noon central time on Saturday, Sunday, and legal holidays].An insurer must have a telephone system capable of accepting or recording incoming phone calls for preauthorizations during times when personnel are not available due to circumstances beyond the insurer's reasonable control [after 6 p.m. central time Monday through Friday and after noon central time on Saturday, Sunday, and legal holidays] and respond [responding] to each of those calls as soon as possible and in no event [not] later than two [24] hours after the call is received. SECTION 5. Section 4201.004(a), Insurance Code is amended to read as follows: (a) A utilization review agent shall: (1) have appropriate personnel reasonably available, by toll-free telephone available 24 hours a day, every day of the year, including on Saturdays, Sundays, and legal holidays [at least 40 hours per week during normal business hours in this state],to discuss patients' care and allow response to telephone review requests; (2) have a telephone system capable, during times when personnel are not available due to circumstances beyond the utilization review agent's reasonable control [during hours other than normal business hours],of accepting or recording incoming telephone calls or of providing instructions to a caller; and (3) respond to a call made during times when personnel are unavailable due to circumstances described in subdivision (2) as soon as possible and in no event [hours other than normal business hours not] later than two hours [the second working day] after the call was received [the later of: (A) the date the call was received; or (B) the date the details necessary to respond have been received from the caller].SECTION 6. This Act takes effect September 1, 2021.