By Giddings H.B. No. 1778
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the medical review of health care provided under the
1-3 workers' compensation insurance system.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 413.051, Labor Code, is amended to read
1-6 as follows:
1-7 Sec. 413.051. CONTRACTS WITH REVIEW ORGANIZATIONS AND HEALTH
1-8 CARE PROVIDERS. (a) The commission may contract with a health
1-9 care provider professional review organization, health care
1-10 provider, or other entity to develop, maintain, or review medical
1-11 policies or fee guidelines or to review compliance with the medical
1-12 policies or fee guidelines.
1-13 (b) For purposes of review or resolution of a dispute as to
1-14 compliance with the medical policies or fee guidelines, the
1-15 commission may contract [only] with a health care provider
1-16 professional review organization, health care provider, or other
1-17 entity that includes in the review process health care
1-18 practitioners who are licensed in the category under review and are
1-19 of the same field or specialty as the category under review.
1-20 (c) The commission may contract with a health care provider
1-21 professional review organization, health care provider, or other
1-22 entity for medical consultant services, including:
1-23 (1) independent medical examinations;
1-24 (2) medical case reviews; or
2-1 (3) establishment of medical policies and fee
2-2 guidelines.
2-3 (d) The commission shall establish standards for contracts
2-4 under this section.
2-5 SECTION 2. Subchapter E, Chapter 413, Labor Code, is amended
2-6 by adding Section 413.0515 to read as follows:
2-7 Sec. 413.0515. MEDICAL ADVISOR. (a) The commission shall
2-8 employ a medical advisor to:
2-9 (1) develop, maintain, and review medical policies and
2-10 fee guidelines, including medical policies regarding the
2-11 determination of impairment ratings;
2-12 (2) review compliance with those medical policies and
2-13 fee guidelines;
2-14 (3) perform other acts related to medical benefits as
2-15 required by the commission; and
2-16 (4) recommend, at least annually, the removal of
2-17 doctors from the commission's list of approved doctors under
2-18 Section 408.023 for any reason outlined in Section 408.023(b) or
2-19 for noncompliance with any policies reviewed under this section.
2-20 (b) The medical advisor may establish a panel of health care
2-21 providers to assist the medical advisor.
2-22 (c) A person, including an entity, that performs or assists
2-23 in the performance of a function for the division has the same
2-24 immunity from liability as a member of the commission under Section
2-25 402.010. The person's actions do not constitute utilization review
2-26 and are not subject to Article 21.58A, Insurance Code.
2-27 (d) The medical advisor must be a doctor as that term is
3-1 defined by Section 401.011.
3-2 SECTION 3. This Act takes effect September 1, 1999.
3-3 SECTION 4. The importance of this legislation and the
3-4 crowded condition of the calendars in both houses create an
3-5 emergency and an imperative public necessity that the
3-6 constitutional rule requiring bills to be read on three several
3-7 days in each house be suspended, and this rule is hereby suspended.