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House Bill 528 |
House Author: Solomons |
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Effective: 6-17-11 |
Senate Sponsor: Van de Putte |
Certified workers' compensation networks allow an insurance carrier to direct an enrolled injured employee to seek workers' compensation health care benefits, except for pharmaceutical benefits, within the network of providers. House Bill 528 amends the Labor Code to establish provisions relating to the provision of pharmaceutical services through informal and voluntary networks. The bill authorizes the reimbursement of prescription medication or services in accordance with fee guidelines adopted by the commissioner of workers' compensation or at a contract rate and prohibits prescription medication or services from being delivered through a workers' compensation health care network under the Workers' Compensation Health Care Network Act or by directly contracting with a health care provider or by contracting through a health benefits pool.
A carrier may pay a health care provider fees for pharmaceutical services that are inconsistent with the fee guidelines adopted by the commissioner only if the carrier has a contract with the health care provider that includes a specific fee schedule. A carrier may use an informal or voluntary network to obtain a contractual agreement for pharmaceutical services that provides for fees different from those authorized under commissioner guidelines. If a carrier chooses to use an informal or voluntary network to obtain such a contractual fee agreement, there must be a contractual agreement between the carrier and the network authorizing the network to contract with health care providers for pharmaceutical services on the carrier's behalf and a contractual agreement between the network and the health care provider that includes a specific fee schedule and that complies with certain notice requirements. The bill imposes reporting requirements on informal and voluntary networks and establishes an administrative violation for carriers and networks that violate its provisions.