Texas’ 89th legislative session produced a number of bills that seek to improve health care and coverage in Texas. Of the bills that made it to Governor Abbott’s desk, we at TACHP have compiled summaries of 10 that we believe are particularly relevant to our member plans and their enrollees.
HB 26: Nutrition Support for Medicaid Recipients
By Rep. Lacey Hull and Sen. Lois Kolkhorst
HB 26 and its companion bill SB 3001 would expand Texas Medicaid recipients’ access to nutritious food and nutrition education. The bill would allow Medicaid managed care organizations to provide nutrition support services to its members in lieu of other services. These services could include nutrition counseling and instruction, but could not include home-delivered meals, food prescriptions, or grocery support.
The bill would also establish a pilot program that allows MCOs to provide more robust nutrition support to members who are pregnant or have certain chronic conditions that could lead to high-risk pregnancies or birth-complications (gestational diabetes, hypertension, or obesity). The support for these recipients could include nutrition counseling and instruction services, medically tailored meals, and other evidence-based nutrition support services designed to improve maternal and infant health outcomes. The program would last until September 1, 2031.
The bill also mandates that, for the duration of the pilot program, the Health and Human Services Commission collect data on the program’s effects on maternal and infant health outcomes and provide a report on its findings, as well as recommendations for further legislative action upon the program’s cessation.
HB 26 was signed by the Governor on June 20 and will take effect on September 1, 2025.
HB 138: Establishing HICCAP
By Rep. Jay Dean and Sen. Paul Bettencourt
HB 138 would establish the Health Impact, Cost, and Coverage Analysis Program (HICCAP) via the Center for Healthcare Data at The University of Texas Health Science Center at Houston. The state may, at any time, submit a request to the program to create an analysis of proposed legislation that imposes a new mandate on health benefit plan issuers or administrators in Texas. The state may not request an analysis of legislation that has already been enacted. The program will analyze the proposed legislation’s potential effects on health outcomes, costs and usage. To fund the program, the state will assess an annual fee from health benefit plan issuers, not including certain group benefits programs or MCOs.
HB 138 was filed without the Governor’s signature on June 20 and took effect immediately.
SB 815: Prohibiting the Use of AI in Adverse Determinations
By Sen. Charles Schwertner and Rep. David Spiller
SB 815 would prohibit any usage of an “automated decision system” when making an adverse determination. An adverse determination occurs when a utilization review agent determines that health care services provided to a patient are not medically necessary or appropriate or are experimental or investigational. TDI may conduct an audit at any time of a utilization review agents’ use of an automated decision system in utilization review.
The bill does not prohibit the usage of automated decision systems, algorithms, or artificial intelligence for administrative support or fraud detection functions.
The bill also requires that additional information be included in the notice of an adverse determination, including the principal reason for the adverse determination, the determination’s clinical basis, a description and the source of the screening criteria and review procedures used in making the adverse determination, and a description of the procedure for the complaint and appeal process, including notice to the enrollee of the enrollee’s right to appeal an adverse determination.
SB 815 was signed by the Governor on June 20 and will take effect on September 1, 2025.
SB 1236: Increasing Transparency and Oversight Between Health Plans, Pharmacy Benefit Managers, and Pharmacies
By Sen. Bryan Hughes and Rep. Cole Hefner
SB 1236 will restructure how health plans and PBMs interact with pharmacies when recouping payments, restructuring contracts, and ensuring transparency.
Plans/PBMs will not be able to deny or reduce a claim payment to a pharmacy unless certain mistakes were made with the claim. If certain mistakes were made, the plan/PBM may only recoup the dispensing fee.
Plans/PBMs will be required to provide pharmacies with a secure online portal that displays all of their contracts with the pharmacy. Pharmacies will have the right to refuse any proposed changes to a contract, and a plan/PBM may not charge any fee before presenting the pharmacy with the contract. Contracts will need to include a fee schedule.
These new regulations do not apply to health plans that are under the Texas state Medicaid program, the federal Medicare program, Texas state child health plans, the TRICARE military health system, or workers’ compensation insurance policies.
SB 1236 was signed by the Governor on May 27 and will take effect on September 1, 2025.
HB 136: Medicaid Coverage for Lactation Consultation Services
By Rep. Lacey Hull and Sen. Carol Alvarado
HB 136 will allow lactation consultation services to be covered under Medicaid. The bill requires HHSC to establish a separate provider type for lactation consultants to enroll and receive reimbursement.
HB 136 was signed by the Governor on May 24 and will take effect on September 1, 2025.
HB 3151: Expedited Credentialing for Health Care Providers
By Rep. Lacey Hull and Sen. Molly Cook
HB 3151 would establish that expedited credentialing and payment would apply to providers who joined a federally qualified health center (FQHC) that had a contract with an MCO, or a medical group/professional practice that had a contract with an MCO and became an FQHC. For a healthcare provider to be considered an FQHC and be eligible for expedited credentialing and payment, the provider must be authorized to provide health services in Texas, submit all documentation required by the MCO to begin the credentialing process, and agree to comply with the terms of the MCO’s participating provider contract. MCOs would be required to use an expedited credentialing process for eligible applicants regardless of whether the applicant specifically requests it.
HB 3151 was signed by the Governor on June 20 and will take effect on September 1, 2025.
SB 963: Allowing MCOs to Market Certain Private Health Benefit Plans
By Sen. Bryan Hughes and Rep. Christian Manuel
SB 963 would allow MCOs to inform an individual of available qualified health plans offered through an exchange and advertise a Medicare Advantage plan or related benefit.
MCOs that share the above information with individuals must also inform the individual of the potential deductibles, copayments, and other cost-sharing requirements. An MCO informing an individual about the availability of a qualified health plan may not offer the individual material or financial incentives for enrolling.
SB 963 was filed without the Governor’s signature on June 20 and will take effect on September 1, 2025.
SB 2544: Mediation for Out-of-Network Health Benefit Claims
By Sen. Kelly Hancock
SB 2544 would allow an out-of-network provider or a health benefit plan issuer/administrator to request a billing mediation.
The request could occur no later than 90 days after the out-of-network provider receives an initial payment for a health care or medical service.
SB 2544 was signed by the Governor on June 20 and took effect immediately.
HB 3812: Amending Provisions Relating to Health Care Provider Preauthorization Requirements
By Rep. Greg Bonnen and Sen. Kelly Hancock
HB 3812 would extend the evaluation period for determining whether a physician or provider qualified for an exemption from preauthorization requirements from once every six months to once every year.
The bill also would add to the conditions for exemption that the physician or provider must have provided the particular health care service at least five times during the evaluation period.
If there were fewer than five claims for a particular health care service submitted by the physician or provider during the most recent evaluation period, the HMO or insurer would be required to review all the claims for that service submitted by the physician or provider during the most recent evaluation period. When conducting an evaluation for an exemption, an HMO or insurer would need to include all preauthorization requests submitted by a physician or provider.
HB 3812 was signed by the Governor on June 20 and will take effect on September 1, 2025.
HB 2254: Authorizing PPBP and EPBP to Provide for Heath Care Services
By Rep. Lacey Hull and Sen. Kevin Sparks
HB 2254 would authorize a preferred provider benefit plan (PPBP) or an exclusive provider benefit plan (EPBP) to provide or arrange for primary health care services with a primary care physician or physician group through a contract for compensation under a fee-for-service arrangement, a risk-sharing arrangement, a capitation arrangement, or any combination of these arrangements.
A primary care physician or physician group that enters into one of these contracts is not considered to be engaging in the business of insurance. Primary care physicians or groups are not required to enter into one of these payment arrangements, and an insurer may not discriminate against those who do participate in these arrangements. Primary care physicians or groups may file a complaint with the department of insurance if they believe that they have been discriminated against.
HB 2254 was signed by the Governor on June 20 and took effect immediately.
