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.