Texans with private health insurance would no longer need their insurer’s advance sign-off before getting emergency care, outpatient mental health treatment or recommended preventive services under identical bills filed Nov. 9 in both chambers of the Texas Legislature. Senate Bill 249 by Sen. Angela Paxton and House Bill 524 by Rep. Suleman Lalani carry word-for-word the same text, drafted by the Texas Legislative Council.
The requirement at issue is preauthorization — an insurer’s approval that a doctor must obtain before providing a service for the plan to pay. Physicians say the process delays care and adds paperwork; insurers say it guards against unnecessary and costly treatment. The bills would remove it for specific categories of care and limit insurers’ ability to take payment back afterward.
Under the bill text, an HMO or insurer could not require a participating doctor or provider to obtain preauthorization for seven kinds of care: emergency care; what the bill calls “intervention-necessary care”; outpatient mental health or substance use treatment, except prescription drugs and IV infusions; certain eye injections given by an ophthalmologist for conditions that may cause sudden vision loss; services rated “A” or “B” by the U.S. Preventive Services Task Force, the federal panel that grades screenings and preventive care; preventive services required under federal coverage rules; and care paid under a fixed per-patient arrangement unless the parties agree otherwise.
“Intervention-necessary care” is defined as non-emergency office or outpatient care for a sudden injury or illness that, left untreated, risks irreversible harm or a trip to the emergency room or hospital — or that a reasonable person without medical training would think needs prompt treatment.
The bills also restrict what happens after the care is delivered. An insurer could not deny or reduce payment for those services unless the provider knowingly and materially misrepresented the service with intent to deceive, or failed to substantially perform it. Any after-the-fact review would require “reasonable cause.” If a provider asks for approval the plan is not allowed to require, the plan must promptly tell the provider in writing that none is needed.
The changes would not apply to Medicaid, Medicaid managed care or the Children’s Health Insurance Program. They would apply to state-regulated plans issued or renewed on or after Jan. 1, 2028. Self-funded employer plans, which are governed by federal law, generally fall outside state insurance mandates.
The filings are part of a larger set of prior-approval proposals. Rep. Cassandra Garcia Hernandez’s House Bill 450 would bar preauthorization for screening mammograms and diagnostic breast imaging, breast reconstruction, inpatient care after a mastectomy, diabetes supplies and bone-mass measurement, according to its text. Other filed bills address same-specialty reviewers, telephone access for approval requests and notice of “gold card” exemptions, according to Legislature filing lists.
Texas already exempts some doctors from prior approval through a 2021 “gold card” law that waives the requirement for physicians whose requests are nearly always approved. The new bills take a different approach, exempting categories of care for every in-network provider rather than individual doctors.
Health insurers have argued in past sessions that broad exemptions raise premiums by removing a check on overuse; the Texas Association of Health Plans, which represents insurers, had not commented on the 2027 bills as of Nov. 13. Medical groups, including the Texas Medical Association, have pushed to reduce prior authorization, citing delayed care. Questions about insurer conduct have also drawn the attention of Attorney General Ken Paxton, who opened an investigation into UnitedHealth Group in October.
The bills await committee referral when the Legislature convenes Jan. 12, 2027.
Key facts
- SB 249 (Paxton) and HB 524 (Lalani), filed Nov. 9, 2026, carry identical text (TLO).
- Would bar preauthorization for emergency care, urgent “intervention-necessary care,” outpatient mental health/substance use treatment, USPSTF A/B services, required preventive care and certain eye injections (bill text).
- Payment denials after care allowed only for knowing, material misrepresentation or failure to perform (bill text).
- Excludes Medicaid and CHIP; applies to plans issued or renewed on or after Jan. 1, 2028 (bill text).