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House Bill 7 |
House Author: Solomons et al. |
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Effective: 9-1-05 |
Senate Sponsor: Staples |
House Bill 7 amends the Labor Code to abolish the Texas Workers' Compensation Commission and transfer its powers and duties, with the exception of the ombudsman program, to the division of workers' compensation within the Texas Department of Insurance. The ombudsman program is transferred to the office of injured employee counsel. The department, division, and office expire September 1, 2009, unless continued by the legislature. The division is administered by the commissioner of workers' compensation, who is appointed by the governor and serves a two-year term.
House Bill 7 requires the commissioner to implement a strategic management plan and to use incentives and performance-based oversight to promote greater overall compliance and performance. The division is required to regularly evaluate and rank the performance of insurance carriers and health care providers and to use the results to focus regulatory oversight on the poor performers and to publicly recognize the high performers. Other powers and duties of the division set forth in the bill include performing workforce education and safety functions and providing education on best practices for return-to-work programs.
The bill establishes the office of injured employee counsel to represent the interests of workers' compensation claimants in this state. The office is administratively attached to the department, but is independent of the department and the division. The bill also establishes the workers' compensation research and evaluation group within the department and specifies the group's research duties. It requires the group to annually prepare and publish a proposed workers' compensation research agenda in the Texas Register for public comment and approval by the commissioner of insurance.
House Bill 7 amends the Insurance Code to authorize the establishment of workers' compensation health care networks for the provision of workers' compensation medical benefits. The bill authorizes a workers' compensation insurance carrier, employers and groups of employers certified to self-insure, and public employers that self-insure to establish or contract with a health care network to provide workers' compensation medical benefits. If an employer elects to receive health care services through a network, employees who live within the network's service area must obtain medical treatment for a compensable injury within the network except for emergency care and approved out-of-network care; employees who do not live within the service area are also the responsibility of the employer's insurance carrier. Networks must be certified by the commissioner of insurance in a manner prescribed by the bill, and group health insurers are authorized to obtain certification. The bill sets forth quality of care requirements for a health care network, including developing and maintaining an ongoing quality improvement program and utilizing a medical case management program with certified case managers. The bill provides for utilization review and retrospective review to evaluate health care that is or has been provided to an injured employee. It requires a utilization review agent to permit an independent review organization to review an adverse determination by the review agent, and it requires the insurance carrier to pay for the review. It requires the workers' compensation research and evaluation group established by the bill to develop and issue an annual informational report card for consumers that compares workers' compensation health care networks with each other and with medical care provided outside of networks.
House Bill 7 requires the commissioner of insurance, not later than December 1 of each even-numbered year, to report to the governor, lieutenant governor, and speaker of the house of representatives regarding the impact of workers' compensation system reforms on the affordability and availability of workers' compensation insurance. It prohibits workers' compensation insurance rates and premiums from being excessive, inadequate, or unfairly discriminatory, and it requires underwriting guidelines to be sound, actuarially justified, or otherwise substantially commensurate with the contemplated risk. It requires each workers' compensation insurer to file a copy of its underwriting guidelines with the department, and it requires the commissioner of insurance to review the information to determine the impact on workers' compensation rates and premiums. The commissioner of insurance is required to conduct a hearing each biennium, beginning not later than December 1, 2008, to review workers' compensation insurance rates.