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Senate Bill 1322 |
Senate Author: Van de Putte |
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Effective: 9-1-13 |
House Sponsor: Oliveira |
Senate Bill 1322 amends the Labor Code to authorize durable medical equipment and home health care services to be reimbursed under the Texas Workers' Compensation Act in accordance with fee guidelines adopted by the commissioner of workers' compensation. Alternatively, the bill authorizes an insurance carrier to pay a health care provider fees for durable medical equipment or home health care services that are inconsistent with the fee guidelines adopted by the commissioner if the carrier or the carrier's authorized agent has a contract with the provider that includes a specific fee schedule. The bill authorizes an insurance carrier or the carrier's authorized agent to use an informal or voluntary network to obtain a contractual agreement providing for fees different from those authorized under the fee guidelines adopted by the commissioner for durable medical equipment or home health services.
If a carrier or the carrier's authorized agent chooses to use an informal or voluntary network to obtain a contractual fee arrangement, the bill requires certain contractual arrangements to exist between the carrier or authorized agent and the informal or voluntary network and between the informal or voluntary network and the health care provider, and requires compliance with certain notice requirements. The bill requires an insurance carrier, or the carrier's authorized agent or an informal or voluntary network at the carrier's request, to provide copies of each such contract to the division of workers' compensation of the Texas Department of Insurance on the request of the division and establishes that the insurance carrier may be required to pay fees in accordance with the division's fee guidelines if the contract does not meet certain criteria or if the carrier or the carrier's authorized agent does not comply with the bill's notice requirements.
Senate Bill 1322 requires an informal or voluntary network, or the carrier or the carrier's authorized agent, to notify each health care provider at least quarterly of any person, other than an injured employee, to which the network's contractual fee arrangements with the health care provider are sold, leased, transferred, or conveyed. The bill sets out provisions relating to the content, format, and delivery of the notice. The bill applies certain reporting requirements to an informal or voluntary network described by the bill's provisions.
Senate Bill 1322 provides that an insurance carrier or the carrier's authorized agent commits an administrative violation if the carrier or agent violates any of the bill's provisions relating to reimbursement for durable medical equipment and home health care services. The bill requires any administrative penalty assessed under the bill to be assessed against the carrier, regardless of whether the carrier or agent committed the violation.