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Signed Into Law
Signed June 20, 2025Effective 2025-06-20
HB3812

Regular Session

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

Government Affairs & Regulatory Compliance Analysis

HB3812: Government Affairs Overview

HB3812 immediately alters the regulatory landscape for Utilization Review (UR) and "Gold Card" preauthorization exemptions. The law disqualifies physicians holding only "administrative medicine" licenses from directing UR and mandates a broader, one-year data lookback across all affiliated plans for exemption eligibility. Health insurers, HMOs, and UR agents must overhaul their physician credentialing and exemption evaluation algorithms immediately to avoid statutory violations.

Rep. Greg Bonnen·House Bill·Regular Session

Critical
Medium Cost
Effective:2025-06-20
Enforcing Agencies

Independent Review Organizations (IRO) • Texas Department of Insurance (TDI)

Business Impact

Who HB3812 Affects

This legislation has regulatory implications for the following Texas businesses and organizations:

Regulatory Priority: critical

Significant regulatory changes (effective 2025-06-20). Review with your legal and compliance teams to understand implications.

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Healthcare

Affected business types:

  • Hospitals
  • Healthcare systems
  • Medical practices
  • Health insurance providers
View all healthcare legislation

Key Operational Considerations

  • 1Provider Manuals: Update manuals to reflect the elimination of the six-month evaluation period and the removal of the June rescission window.
  • 2Rescission Reviewers: Staffing for retrospective reviews to rescind exemptions must be adjusted. You must ensure reviewers are of the same or similar specialty as the provider being reviewed.

Estimated Cost Impact

mediumModerate costs expected for implementation.

Enforcing Agencies

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HB3812
Relating to health benefit plan preauthorization requirements for certain health care services and the direction of utilization review by physicians.
Critical Urgency
Heavily Contested
House Vote116 - 23
YEA
NAY
83% in favor139 voting
Senate Vote30 - 1
YEA
97% in favor31 voting
24
Total Opposition Votes
Cost Impact
Medium
Effective
2025-06-20
Enforcing Agencies
IROTDI
Primary Author: Rep. Greg Bonnen
89th Texas Legislature
jdkey.com
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Compliance Analysis

Key implementation requirements and action items for compliance with this legislation

Implementation Timeline

  • Effective Date: June 20, 2025 (Immediately effective).
  • Compliance Deadline:
  • UR Licensure: Immediate. Any UR decision made today by a physician without a full Texas license is non-compliant.
  • Exemption Logic: The next evaluation cycle must utilize the new 1-year lookback and affiliate data aggregation.
  • Rescission Window: The June rescission window is eliminated; the next valid window to rescind an exemption is January 2026.
  • Agency Rulemaking:
  • TDI: Must prescribe the form and manner for the new Annual Exemption Report. Until this rule is published, carriers are in a "regulatory gray zone"—you must track the data now (exemptions, denials, IRO outcomes) to ensure you can populate the report once the format is finalized.

Immediate Action Plan

  • 1. Stop June Rescissions: Cancel any planned rescission of "Gold Card" status for June 2025. The law now restricts rescissions to January only.
  • 2. Audit Licensure: Verify today that every physician directing your UR holds a full Texas medical license.
  • 3. Update Lookback Logic: Instruct IT/Data teams to switch the exemption evaluation algorithm from a 6-month lookback to a 1-year lookback effective immediately.
  • 4. Preserve Data: Ensure your systems are capturing the specific data points required for the forthcoming TDI Annual Report.

Operational Changes Required

Contracts

  • UR Vendor Agreements (MSAs): You must immediately amend Master Services Agreements with third-party UR vendors. Insert a warranty clause requiring that all Medical Directors hold a full, unrestricted license to practice medicine in Texas. Explicitly prohibit the use of physicians holding only an "administrative medicine" license (Occupations Code Sec. 155.009).
  • Provider Manuals: Update manuals to reflect the elimination of the six-month evaluation period and the removal of the June rescission window.

Hiring/Training

  • Medical Director Audits: Conduct an immediate licensure audit of all internal and external physicians directing UR. If a director holds an administrative license, they must be removed from the UR role immediately.
  • Rescission Reviewers: Staffing for retrospective reviews to rescind exemptions must be adjusted. You must ensure reviewers are of the same or similar specialty as the provider being reviewed.

Reporting & Record-Keeping

  • Data Aggregation Logic: IT systems must be reprogrammed to aggregate preauthorization data across all affiliated plans. You can no longer silo data by specific plan or line of business when calculating a provider's 90% approval rate.
  • Rescission Notice Packets: When notifying a provider of a rescission, you must now attach the specific data for the 5-to-20 claim random sample used to make the determination.
  • New Annual Report: Begin internal tracking of:
  • 1. Total exemptions granted.
  • 2. Total exemptions rescinded/denied.
  • 3. Total IRO requests regarding exemption disputes and their outcomes.

Fees & Costs

  • Maintenance Taxes: Expect a marginal increase in maintenance tax assessments to cover the $1.05 million cost for TDI to build the new reporting database.
  • Litigation Risk: The Texas Medical Board (TMB) is now authorized to levy administrative penalties against physicians who direct UR without "medical justification." This increases the cost of insuring or indemnifying your Medical Directors.

Strategic Ambiguities & Considerations

  • Scope of "Affiliate": The requirement to aggregate data across "any affiliate" is broad. It is currently unclear if this extends to Third-Party Administrator (TPA) business lines where the carrier administers the plan but does not hold the risk. Until TDI clarifies via rulemaking, adopt a conservative interpretation and aggregate broadly to prevent valid complaints of non-compliance.
  • "Similar Specialty": The law requires rescission reviews by a physician of the "same or similar specialty." This term is subjective. Expect Independent Review Organizations (IROs) to strictly interpret this against the carrier during disputes.

Need Compliance Guidance on This Legislation?

JD Key Consulting specializes in Texas regulatory compliance strategy. Work directly with James Dickey—former Chairman of the Republican Party of Texas—to understand this bill's impact on your operations and develop an actionable compliance plan.

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Information presented is for general knowledge only and is provided without warranty, express or implied. Consult qualified government affairs professionals and legal counsel before making compliance decisions.

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Legislative Timeline

This bill's path through the Texas Legislature

Filed
Mar 5, 2025
Passed House
May 15, 2025
Passed Senate
May 27, 2025
Signed
Jun 20, 2025
Effective
Jun 20, 2025
TopicsHealth Care ProvidersInsuranceInsurance--health & AccidentInsurance--insurers & AgentsOccupational RegulationOccupational Regulation--health OccupationsOpen RecordsHealth Maintenance OrganizationsHealth & Human Services CommissionMedical Board, TexasState Health Services, Department ofPhysicians
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House Authors

Rep. Greg BonnenRepublican · Primary Author
Joint Authors
Coauthors (5)

Senate Sponsors

Sen. Kelly HancockRepublican · Primary Sponsor
Cosponsors (2)

Bill Text(with markup)

View bill text in multiple formats on Texas Legislature website

Fiscal NoteView Original

Related Legislation

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More from Rep. Greg Bonnen

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Related by Topic

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Quick Reference

Frequently Asked Questions

Common questions about HB3812

Q

What does Texas HB3812 do?

HB3812 immediately alters the regulatory landscape for Utilization Review (UR) and "Gold Card" preauthorization exemptions. The law disqualifies physicians holding only "administrative medicine" licenses from directing UR and mandates a broader, one-year data lookback across all affiliated plans for exemption eligibility. Health insurers, HMOs, and UR agents must overhaul their physician credentialing and exemption evaluation algorithms immediately to avoid statutory violations.

Q

Who authored HB3812?

HB3812 was authored by Texas Representative Greg Bonnen during the Regular Session.

Q

When was HB3812 signed into law?

HB3812 was signed into law by Governor Greg Abbott on June 20, 2025.

Q

Which agencies enforce HB3812?

HB3812 is enforced by Independent Review Organizations (IRO) and Texas Department of Insurance (TDI).

Q

How significant are the changes in HB3812?

The regulatory priority for HB3812 is rated as "critical". Businesses and organizations should review the legislation to understand potential impacts.

Q

What is the cost impact of HB3812?

The cost impact of HB3812 is estimated as "medium". This may vary based on industry and implementation requirements.

Q

What topics does HB3812 address?

HB3812 addresses topics including health care providers, insurance, insurance--health & accident, insurance--insurers & agents and occupational regulation.

Q

What are the key dates for HB3812?

Key dates for HB3812: Effective date is 2025-06-20. Rulemaking: Prescribe the form and manner for the new annual 'Gold Card' exemption and denial report. (TBD (Post-Enactment)). Consult with legal counsel regarding applicability.

Q

Which Texas businesses are affected by HB3812?

HB3812 primarily affects healthcare providers and medical facilities, insurance companies and financial institutions. These businesses should review the legislation with their legal and compliance teams to understand potential impacts.

Need Strategic Guidance on This Legislation?

JD Key Consulting is an Austin, Texas-based government affairs firm led by James Dickey, former Chairman of the Republican Party of Texas. We specialize in Texas regulatory compliance and legislative strategy for data centers, energy, banking, and manufacturing.

Legislative data provided by LegiScanLast updated: January 11, 2026