TX HB4037

Health benefit plans that cover medically necessary anesthesia must provide coverage for the full duration that anesthesia services are performed, without time-based limitations

Managed care plans under the state group benefits program must ensure adequate provider networks by accounting for patient physical status assessments and complexity/urgency of care as determined by treating physicians

Disease management services under state employee (Chapter 1551), teacher retirement (Chapter 1575), and school employee (Chapter 1579) health plans must consider patient physical status and complexity of care identified by clinicians

Medical necessity determinations and benefit payment calculations must factor in patient physical status assessments and complexity/urgency of care as determined by the treating physician or healthcare provider

Applies to health benefit plans delivered, issued, or renewed on or after January 1, 2026, with the act taking effect September 1, 2025