MPM, MSH C.S.H.B. 1192 77(R)    BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 1192
By: Brimer
Business & Industry
3/19/2001
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

Current law entitles state employees to receive medical benefits for
injuries sustained while on the job. Except in an emergency, employees are
required to seek medical treatment from a list of doctors approved by the
Texas Workers' Compensation Commission (TWCC).  The list includes each
doctor licensed in this state on January 1, 1993, except those who have
been removed by TWCC from the lists for certain questionable practices.
C.S.H.B. 1192 creates a pilot program that contracts with a network of
doctors known as gateway doctors to provide medical treatment to injured
state employees to evaluate the effectiveness of the use of gateway doctors
in reducing costs incurred by the state and in providing better treatment
to injured workers.   

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the risk management board and the board
of directors of the Research and Oversight Council on Workers' Compensation
in SECTION 1 (Section 412.065, Labor Code) and SECTION 4 of this bill. 

ANALYSIS

C.S.H.B. 1192 amends the Labor Code to require the State Office of Risk
Management (office) and the Research and Oversight Council on Workers'
Compensation (council) to jointly develop and implement a pilot program
(program) to provide medical benefits to certain state employees who
sustain compensable injuries through the use of one or more health care
delivery networks under which health care is provided by specific health
care doctors or chiropractors under contract (gateway doctors).  The bill
requires the office and the council to jointly select a limited number of
state agencies to participate in the program and provides that the selected
agencies are required to participate.  The bill requires the office and the
council to design the program in a manner that: 

_provides state employees and the management of participating state
agencies the opportunity for input regarding the health care practitioners
and providers used by the program and returnto-work coordination
appropriate for the program; 

_enhances the delivery of medical benefits by providing better health care
and faster access to that care; 

_allows employees access to networks of physicians and chiropractors that
are effectively monitored for appropriate credentials, provision of quality
care, enhancement of the return to work of injured employees, and
cost-effective outcomes; and  

_enables the state to determine whether extension of the use of a health
care delivery network and gateway doctors would decrease direct costs
associated with the operation of the state employee workers' compensation
program. 

The bill requires the office and the council to submit a written report to
the legislature concerning the  effectiveness of the program in reducing
state medical benefits costs no later than February 1 of each oddnumbered
year.  The bill authorizes the risk management board (board) and the board
of directors of the council to adopt rules and enter into contracts as
necessary or appropriate to implement the program not later than December
1, 2001.  The bill exempts employees participating in the program from
provisions requiring them to receive medical treatment, as it relates to
workers' compensation benefits, from a doctor chosen from a list of doctors
approved by the Texas Workers' Compensation Commission. 

The bill provides that employees of agencies participating in the program
are required to use the  services of a gateway doctor or specialist
participating in the program to receive medical benefits.  The bill
entitles an employee to select an initial treating doctor from the list of
gateway doctors.  The bill requires the board to provide employees of
participating agencies with a list of participating gateway doctors or
specialists. 

EFFECTIVE DATE

September 1, 2001, and applies only to a claim for workers' compensation
benefits based on a compensable injury that occurs on or after January 1,
2002. 

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 1192 differs from the original by including a chiropractor in the
definition of gateway doctor. 

The substitute specifies that services to state employees under the gateway
doctor pilot program (pilot program) are delivered through one or more
health care delivery networks rather than a single network. The substitute
modifies the manner in which the State Office of Risk Management and the
Research and Oversight Council on Workers' Compensation are required to
develop the pilot program to include the provisions that the program
provide state employees and the management of participating state agencies
the opportunity for certain input regarding the pilot program and allow
employees access to networks of physicians and chiropractors that are
effectively monitored.