May 05, 2015
On April 23, 2015, the Texas Department of Insurance adopted a rule related to Independent Review Organizations (IROs), updating Insurance Code 4202 to conform to HB 2645 which was passed during the 2013 legislative session. As background, an IRO is an entity that performs independent external reviews of adverse benefit determinations and final adverse benefit determinations under state or federal external review procedures. Among other changes, the legislation requires each IRO to make a determination pertaining to a life-threatening condition no later than the earlier of the third day (rather than the fifth day) after the date the IRS receives the information necessary to make the determination. It also directs the Insurance Commissioner to adopt standards and rules for the certification, selection and operation of IROs, which this rule fulfills. While this rule does not apply specifically to employers, it may be helpful for employers to be familiar with the role of IROs and how they must operate within the state. The rule is effective July 1, 2015.
Adopted Rule »