SRC-JFA, JFA H.B. 3197 75(R)   BILL ANALYSIS


Senate Research Center   H.B. 3197
By: Janek (Moncrief)
Economic Development
5-12-97
Engrossed


DIGEST 

Currently, insurance carriers contract with utilization review agents to
make determinations on the medical necessity of care delivered to
patients.  Utilization review agents are regulated under general health
insurance policies by the Texas Department of Insurance (department).
Many workers' compensation insurance carriers contract with utilization
review agents to make determinations on the medical necessity of health
care delivered to injured patients.  There are no provisions under the
Labor Code, however, that provide for regulation of utilization review
agents performing reviews of workers' compensation medical cases.  This
bill would amend the Insurance Code to provide for regulation by the
department of utilization review agents who conduct utilization reviews
under the workers' compensation statute.   

PURPOSE

As proposed, H.B. 3197 revises the Insurance Code to provide for
regulation by the Texas Department of Insurance of utilization review
agents who conduct utilization reviews under the workers' compensation
statute.   

RULEMAKING AUTHORITY

Rulemaking authority is granted to the commissioner of insurance and the
Texas Workers' Compensation Commission in SECTION 1 (Section 14(c),
Article 21.58A, Insurance Code) of this bill.  

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 14(c), Article 21.58A, Insurance Code, to
provide that except as otherwise provided by this subsection, this article
applies, rather than shall not apply, to utilization review of health care
services provided to persons eligible for workers' compensation medical
benefits  under Title 5, Labor Code, rather than to patients under the
authority of the Texas Workers' Compensation Act (Article 8308-1.01 et
seq., V.T.C.S.).  Requires the commissioner of insurance (commissioner) to
regulate in the manner provided by this article a person who performs
review of a medical benefit provided under Chapter 408, Labor Code.
Provides that this subsection does not affect the authority of the Texas
Workers' Compensation Commission (TWCC) to exercise the powers granted to
TWCC under Title 5, Labor Code.  Provides that in the event of a conflict
between this article and Title 5, Labor Code, Title 5, Labor Code,
prevails.  Authorizes the commissioner and TWCC to adopt rules and enter
into memoranda of understanding as necessary to implement this subsection.

SECTION 2. Effective date: September 1, 1997.
  Makes application of this Act prospective to January 1, 1998. 

SECTION 3. Emergency clause.