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House Bill 2605 |
House Author: Taylor, Larry |
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Effective: 9-1-11 |
Senate Sponsor: Huffman |
House Bill 2605 amends the Insurance Code to continue the division of workers' compensation of the Texas Department of Insurance until September 1, 2017. In addition to enacting standard across-the-board sunset provisions and revising provisions relating to appeals of medical necessity disputes, the bill restructures appeals of independent review organization determinations to include a contested case hearing before the division and authorizes judicial review of a final decision of the division.
The bill amends the Labor Code to revise administrative procedures relating to the complaint process, the designated doctor selection process, and the appeals process. The bill gives the division the authority to conduct all contested case hearings for medical necessity disputes, removes the State Office of Administrative Hearings' jurisdiction over such hearings, and provides for the appeal of a final decision by the division directly to district court. The bill transfers the division's authority to conduct medical fee contested case hearings to the State Office of Administrative Hearings.
The bill sets out requirements and procedures relating to the medical quality review process, the establishment of a quality assurance panel within the medical quality review panel, inspections of persons regulated by the division, and the division's investigation unit. The bill authorizes the commissioner to issue emergency cease and desist orders and makes an order of the commissioner subject to judicial review under the substantial evidence rule. The bill updates enforcement provisions related to the Texas Workers' Compensation Act and requires all administrative penalties collected by the division to be deposited into the general revenue fund instead of the operating account of the Texas Department of Insurance.
The bill entitles a party to a medical dispute involving an employee of a political subdivision to a contested case hearing on and judicial review of an independent review organization's determination. A political subdivision, the division, and an insurance carrier are required to accelerate and give priority to an injured first responder's claim for medical benefits.