By Brimer H.B. No. 2545
76R5011 CMR-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to workers' compensation medical benefits, claims
1-3 regarding those benefits, and requirements imposed on health care
1-4 providers who provide services relating to those benefits.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section 408.022(b), Labor Code, is amended to
1-7 read as follows:
1-8 (b) If an employee is dissatisfied with the initial choice
1-9 of a doctor from the commission's list, on written application to
1-10 and approval by [the employee may notify] the commission, the
1-11 employee may [and request authority to] select an alternate doctor.
1-12 Unless the insurance carrier agrees to the employee's requested
1-13 [The notification must be in writing stating the reasons for the]
1-14 change, the commission must determine that the change is medically
1-15 warranted before approving the [except notification may be by
1-16 telephone when a medical necessity exists for immediate] change.
1-17 Before denying a request for a change in treating doctors, the
1-18 commission shall consider whether an independent medical
1-19 consultation is necessary to evaluate the appropriateness of the
1-20 treating doctor's diagnosis or treatment. The commission shall
1-21 notify the employee of its decision not later than the 10th day
1-22 after the date on which the employee's request is received by the
1-23 commission.
1-24 SECTION 2. Section 408.027, Labor Code, is amended by
2-1 amending Subsections (a) and (b) and adding Subsection (e) to read
2-2 as follows:
2-3 (a) An insurance carrier shall pay the fee charged for a
2-4 service rendered by a health care provider not later than the 20th
2-5 [45th] day after the date the insurance carrier receives the charge
2-6 unless the amount of the payment or the entitlement to payment is
2-7 disputed.
2-8 (b) If an insurance carrier disputes the amount charged by a
2-9 health care provider and requests an audit of the services
2-10 rendered, the insurance carrier shall pay 50 percent of the amount
2-11 charged by the health care provider not later than the 20th [45th]
2-12 day after the date the insurance carrier receives the statement of
2-13 charge.
2-14 (e) Notwithstanding Subsections (a) and (b), an insurance
2-15 carrier shall pay the fee charged for a service rendered by a
2-16 health care provider not later than the 31st day after the date the
2-17 insurance carrier receives the charge unless the amount of the
2-18 payment or the entitlement to payment is disputed.
2-19 SECTION 3. Section 413.012, Labor Code, is amended to read
2-20 as follows:
2-21 Sec. 413.012. MEDICAL POLICY AND GUIDELINE UPDATES REQUIRED.
2-22 (a) The medical policies and fee guidelines shall be reviewed and
2-23 revised at least every two years to reflect fair and reasonable
2-24 fees and to reflect medical treatment or ranges of treatment that
2-25 are reasonable or necessary at the time the review and revision is
2-26 conducted.
2-27 (b) If the medical policies and fee guidelines are not
3-1 reviewed within the period prescribed by Subsection (a), the fees
3-2 provided in the guideline shall be increased by three percent each
3-3 year until the medical policy or fee guideline is revised or
3-4 repealed.
3-5 SECTION 4. Section 413.014, Labor Code, is amended by adding
3-6 Subsections (c), (d), and (e) to read as follows:
3-7 (c) The commission may impose additional reimbursement
3-8 restrictions and preauthorization requirements on a health care
3-9 provider for noncompliance with this title or commission rules if
3-10 the commission previously notified the health care provider of the
3-11 noncompliance.
3-12 (d) A person who performs or assists in performing services
3-13 under this section for the commission has the same immunity from
3-14 liability that a commission member has under Section 402.010.
3-15 (e) An act by the commission under this section does not
3-16 constitute utilization review and is not subject to Article 21.58A,
3-17 Insurance Code.
3-18 SECTION 5. Section 413.019, Labor Code, is amended by
3-19 amending Subsection (a) and adding Subsection (c) to read as
3-20 follows:
3-21 (a) Interest on an unpaid fee or charge that is consistent
3-22 with the fee guidelines accrues at the rate provided by Section
3-23 401.023 beginning on the 20th [60th] day after the date the health
3-24 care provider submits the bill to an insurance carrier until the
3-25 date the bill is paid.
3-26 (c) Notwithstanding Subsection (a), interest on an unpaid
3-27 fee or charge that is consistent with the fee guidelines accrues at
4-1 the rate provided by Section 401.023 beginning on the 30th day
4-2 after the date the health care provider submits the bill to an
4-3 insurance carrier until the date the bill is paid. This subsection
4-4 expires September 1, 2001.
4-5 SECTION 6. Section 413.042(a), Labor Code, is amended to
4-6 read as follows:
4-7 (a) A health care provider or any other person may not
4-8 pursue a private claim against a workers' compensation claimant for
4-9 all or part of the cost of a health care service provided to the
4-10 claimant by the provider unless:
4-11 (1) the injury is finally adjudicated not compensable
4-12 under this subtitle; or
4-13 (2) the employee violates Section 408.022 relating to
4-14 the selection of a doctor and the doctor did not know of the
4-15 violation at the time the services were rendered.
4-16 SECTION 7. (a) This Act takes effect September 1, 1999, and
4-17 applies only to a claim for workers' compensation medical benefits
4-18 filed on or after that date. A claim that is filed before the
4-19 effective date of this Act is governed by the law in effect on the
4-20 date that the claim was filed, and the former law is continued in
4-21 effect for that purpose.
4-22 (b) The change in law made by Sections 2 and 5 of this Act
4-23 applies only to payment for services rendered to an injured worker
4-24 by a health care provider based on a charge that is submitted to an
4-25 insurance carrier for payment on or after the effective date of
4-26 this Act. A charge submitted before that date is governed by the
4-27 law in effect on the date that the charge was submitted, and the
5-1 former law is continued in effect for that purpose.
5-2 SECTION 8. The importance of this legislation and the
5-3 crowded condition of the calendars in both houses create an
5-4 emergency and an imperative public necessity that the
5-5 constitutional rule requiring bills to be read on three several
5-6 days in each house be suspended, and this rule is hereby suspended.