By Seidlits H.B. No. 1449
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to medical benefits under the Texas Workers' Compensation
1-3 Act.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 4.63, Texas Workers' Compensation Act, is
1-6 amended to read as follows:
1-7 Section 4.63. Selection of Doctor. (a) This section takes
1-8 effect September <January> 1, 1993.
1-9 (b) Except in an emergency, the commission shall require the
1-10 employee to receive medical treatment from a doctor chosen from a
1-11 list of doctors approved by the commission. The employee is
1-12 entitled to the employee's initial choice of a doctor from the
1-13 commission's list.
1-14 (c) If the employee is dissatisfied with the employee's
1-15 initial choice of doctor from the commission's list, the employee
1-16 may change doctors once on submission to the commission in writing
1-17 of the reasons for the employee's change in doctors. Thereafter,
1-18 if the employee is dissatisfied with the employee's choice of
1-19 doctor from the commission's list, the employee may notify the
1-20 commission and request authority to select an alternate doctor.
1-21 The notification should be in writing stating the reasons for the
1-22 change, except notification may be by telephone when a medical
1-23 necessity exists for immediate change.
2-1 (d) The commission will prescribe criteria by which the
2-2 commission will grant the employee authority to select an alternate
2-3 doctor. As criteria, the commission may include but is not limited
2-4 to:
2-5 (1) whether treatment by the current doctor is
2-6 medically inappropriate;
2-7 (2) the professional reputation of the doctor;
2-8 (3) whether the employee is receiving appropriate
2-9 medical care to reach maximum medical improvement; and
2-10 (4) whether a conflict exists or has developed between
2-11 the employee and the doctor to the extent that the doctor-patient
2-12 relationship is jeopardized or impaired.
2-13 (e) Any change of doctor may not be made for the purpose of
2-14 securing a new impairment rating or medical report.
2-15 (f) For the purposes of this section, all doctors duly
2-16 licensed in this state are included on the list at the time of the
2-17 effective date of this section or on their licensure in this state.
2-18 Doctors not licensed in this state but licensed in another state or
2-19 jurisdiction who treat employees may apply with the commission for
2-20 inclusion on the approved list.
2-21 (g) The commission shall establish criteria for deleting a
2-22 doctor from the approved list. The criteria may include anything
2-23 considered relevant by the commission and may include but are not
2-24 limited to:
2-25 (1) sanctions of the doctor by the commission for
3-1 violations of Article 10 of this Act;
3-2 (2) sanctions by the Medicare or Medicaid program
3-3 which are based on substandard medical care, overcharging, or
3-4 overutilization of medical services;
3-5 (3) evidence from the commission's medical records
3-6 that the doctor's charges, fees, diagnoses, or treatments are
3-7 substantially different from those the commission finds to be fair
3-8 and reasonable; and
3-9 (4) suspension of a doctor's license by the
3-10 appropriate licensing authority.
3-11 (h) The commission shall establish procedures for
3-12 application for reinstatement to the list.
3-13 SECTION 2. The importance of this legislation and the
3-14 crowded condition of the calendars in both houses create an
3-15 emergency and an imperative public necessity that the
3-16 constitutional rule requiring bills to be read on three several
3-17 days in each house be suspended, and this rule is hereby suspended,
3-18 and that this Act take effect and be in force from and after its
3-19 passage, and it is so enacted.