By: Lucio S.B. No. 1252
A BILL TO BE ENTITLED
AN ACT
1-1 relating to selection of doctors under the Texas Workers'
1-2 Compensation Act.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 4.63, Texas Workers' Compensation Act
1-5 (Article 8308-4.63, Vernon's Texas Civil Statutes), is amended to
1-6 read as follows:
1-7 Section 4.63. Selection of doctor. (a) <This section takes
1-8 effect January 1, 1993.>
1-9 <(b)> Except in an emergency, the commission shall require
1-10 the employee to receive medical treatment from a doctor chosen from
1-11 a 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 (b) <(c)> If the employee is dissatisfied with the
1-15 employee's initial choice of doctor from the commission's list, the
1-16 employee may change doctors once on submission to the commission in
1-17 writing of the reasons for the employee's change in doctors.
1-18 Thereafter, if the employee is dissatisfied with the employee's
1-19 choice of doctor from the commission's list, the employee may
1-20 notify the commission and request authority to select an alternate
1-21 doctor. The notification should be in writing stating the reasons
1-22 for the change, except notification may be by telephone when a
1-23 medical necessity exists for immediate change.
2-1 (c) <(d)> The commission will prescribe criteria by which
2-2 the commission will grant the employee authority to select an
2-3 alternate doctor. As criteria, the commission may include but is
2-4 not limited 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 (d) <(e)> Any change of doctor may not be made for the
2-14 purpose of securing a new impairment rating or medical report.
2-15 (e) <(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 (f) <(g)> The commission shall establish criteria for
2-22 deleting a doctor from the approved list. The criteria may include
2-23 anything considered relevant by the commission and may include but
2-24 are not 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 (g) <(h)> The commission shall establish procedures for
3-12 application for reinstatement to the list.
3-13 SECTION 2. This Act takes effect September 1, 1993.
3-14 SECTION 3. The importance of this legislation and the
3-15 crowded condition of the calendars in both houses create an
3-16 emergency and an imperative public necessity that the
3-17 constitutional rule requiring bills to be read on three several
3-18 days in each house be suspended, and this rule is hereby suspended.