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TexasHB 381289th Legislature Regular SessionHouse

Relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.

Sponsored By: Greg Bonnen, Hancock, Venton Jones, Tom Oliverson

Signed by Governor

Health Care ProvidersInsurance--Health & AccidentInsurance--Insurers & AgentsOccupational Regulation--Health OccupationsOpen RecordsHEALTH MAINTENANCE ORGANIZATIONSPHYSICIANSHEALTH & HUMAN SERVICES COMMISSIONMEDICAL BOARD, TEXASSTATE HEALTH SERVICES, DEPARTMENT OF

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 1 costs, 0 mixed.

Qualifying providers can skip prior approval

Beginning September 1, 2025, qualifying providers can skip health plan approval before giving a specific service. The insurer must have approved, or would have approved, at least 90% of requests during the latest one-year evaluation period. The provider must also have given that service at least five times during that period. Insurers check eligibility yearly, counting requests across all plans they and their affiliates issue or administer. The exemption applies across those plans, reducing prior approval requirements for patients using that provider.

Stronger safeguards for health plan reviews

Beginning September 1, 2025, health plan service reviews must be directed by Texas-licensed physicians without administrative-medicine licenses. Before removing a prior approval exemption, insurers must review all claims for that service from the latest evaluation period. A Texas-licensed physician makes the decision and, when reviewing a physician, must have the same or a similar specialty. Providers can get independent review of the removal without first completing an internal appeal.

Providers face longer waits after exemption denials

A provider faces a waiting period after a final decision upholds denial or removal of a prior approval exemption. For that same service, reconsideration must wait until the next one-year evaluation period ends. That period follows the evaluation period used for the denial or removal. Patients may remain subject to prior approval during this wait.

Sponsors & Cosponsors

Sponsors

  • Greg Bonnen

    House

  • Hancock

    Affiliation unavailable

  • Venton Jones

    House

  • Tom Oliverson

    House

Cosponsors

  • R.D. "Bobby" Guerra

    House

  • Cody Harris

    House

  • Carrie Isaac

    House

  • Nathan Johnson

    Democratic • Senate

  • Janie Lopez

    House

  • Will Metcalf

    House

  • Charles Schwertner

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 241 • No: 50

Senate vote • 5/27/2025

Record vote

Yes: 0 • No: 0

Senate vote • 5/27/2025

Record vote

Yes: 0 • No: 0

House vote • 5/15/2025

Record vote

Yes: 116 • No: 26

House vote • 5/14/2025

Record vote

Yes: 110 • No: 23

House vote • Unknown

Committee vote: Insurance

Yes: 7 • No: 1

Senate vote • Unknown

Committee vote: Health & Human Services

Yes: 8 • No: 0

Actions Timeline

  1. Effective on 9/1/25

    6/20/2025House

  2. Signed by the Governor

    6/20/2025House

  3. Sent to the Governor

    5/30/2025House

  4. Signed in the Senate

    5/28/2025Senate

  5. Signed in the House

    5/28/2025House

  6. Reported enrolled

    5/28/2025House

  7. Senate passage reported

    5/28/2025House

  8. Placed on local & uncontested calendar

    5/28/2025Senate

  9. Record vote

    5/27/2025Senate

  10. Passed

    5/27/2025Senate

  11. Read 3rd time

    5/27/2025Senate

  12. Record vote

    5/27/2025Senate

  13. Three day rule suspended

    5/27/2025Senate

  14. Vote recorded in Journal

    5/27/2025Senate

  15. Read 2nd time & passed to 3rd reading

    5/27/2025Senate

  16. Rules suspended-Regular order of business

    5/27/2025Senate

  17. Co-sponsor authorized

    5/27/2025Senate

  18. Placed on intent calendar

    5/26/2025Senate

  19. Committee report printed and distributed

    5/23/2025Senate

  20. Recommended for local & uncontested calendar

    5/23/2025Senate

  21. Reported favorably w/o amendments

    5/23/2025Senate

  22. Vote taken in committee

    5/21/2025Senate

  23. Considered in public hearing

    5/21/2025Senate

  24. Left pending in committee

    5/20/2025Senate

  25. Testimony taken in committee

    5/20/2025Senate

Bill Text

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