By Jones of Dallas                              H.B. No. 1003

      75R4592 PB-F                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to the provision by health maintenance organizations and

 1-3     certain other managed care entities of health care services for a

 1-4     compensable injury; providing an administrative penalty.

 1-5           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-6           SECTION 1.  Subchapter B, Chapter 408, Labor Code, is amended

 1-7     by adding Section 408.029 to read as follows:

 1-8           Sec. 408.029.  HEALTH CARE PROVIDED THROUGH MANAGED CARE

 1-9     ENTITY.  (a)  An employee who sustains a compensable injury and who

1-10     receives health care for that injury through a health maintenance

1-11     organization or another managed care entity in which a doctor is

1-12     compensated on a capitated basis is entitled to receive the care

1-13     from a physician or other approved doctor.  If the health

1-14     maintenance organization or other managed care entity provides the

1-15     health care through the services of a physician assistant,

1-16     registered nurse, licensed vocational nurse, or other health care

1-17     practitioner who is not a doctor, the health maintenance

1-18     organization or entity must notify the injured employee in writing

1-19     that the employee is entitled to have health care provided by a

1-20     doctor.  If the employee elects to have health care provided by a

1-21     doctor, the health maintenance organization or entity may not

1-22     release the employee from treatment for the compensable injury

1-23     until the employee has been examined by a doctor.

1-24           (b)  A health maintenance organization or other managed care

 2-1     entity that violates Subsection (a) commits a Class A

 2-2     administrative violation punishable as provided by Chapter 415.

 2-3           (c)  In this section, "health maintenance organization" has

 2-4     the meaning assigned by the Texas Health Maintenance Organization

 2-5     Act (Chapter 20A, Vernon's Texas Insurance Code).

 2-6           SECTION 2.  This Act takes effect September 1, 1997, and

 2-7     applies only to the treatment of an injury that is compensable for

 2-8     the purpose of workers' compensation benefits and that occurs on or

 2-9     after that date.  Treatment for a compensable injury that occurs

2-10     before that date is governed by the law in effect on the date the

2-11     compensable injury occurred, and the former law is continued in

2-12     effect for that purpose.

2-13           SECTION 3.  The importance of this legislation and the

2-14     crowded condition of the calendars in both houses create an

2-15     emergency and an imperative public necessity that the

2-16     constitutional rule requiring bills to be read on three several

2-17     days in each house be suspended, and this rule is hereby suspended.