TX SB1380

Prohibits health maintenance organizations and insurers from requiring preauthorization for emergency care, intervention-necessary care provided by licensed physicians, outpatient mental health and substance use disorder treatment (excluding prescription drugs and IV infusions), and preventive services with "A" or "B" ratings from the U.S. Preventive Services Task Force

Exempts intravitreal prescription drugs and ophthalmology services following National Eye Institute guidelines for conditions that may cause immediate vision loss from preauthorization requirements

Prevents insurers from denying or reducing payment for exempt services unless the physician knowingly misrepresented the service with intent to deceive or failed to substantially perform the service

Restricts retrospective reviews of exempt services to cases where the insurer has reasonable cause to suspect fraud or non-performance

Applies to HMO and preferred/exclusive provider benefit plans but excludes CHIP, Medicaid, and Medicaid managed care programs; takes effect September 1, 2025, for plans delivered or renewed on or after January 1, 2026