77R9042 PB-D
By Brimer H.B. No. 1192
Substitute the following for H.B. No. 1192:
By Brimer C.S.H.B. No. 1192
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a gateway doctor pilot program for the provision of
1-3 medical benefits to certain state employees who sustain compensable
1-4 injuries.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Chapter 412, Labor Code, is amended by adding
1-7 Subchapter G to read as follows:
1-8 SUBCHAPTER G. GATEWAY DOCTOR PILOT PROGRAM
1-9 Sec. 412.061. DEFINITIONS. In this subchapter:
1-10 (1) "Council" means the Research and Oversight Council
1-11 on Workers' Compensation.
1-12 (2) "Gateway doctor" means a physician or chiropractor
1-13 who is a member of a health care delivery network with which the
1-14 state contracts for the provision of services under the pilot
1-15 program.
1-16 (3) "Health care delivery network" means a health care
1-17 delivery system under which health care services are provided by
1-18 specific health care practitioners or providers under contract.
1-19 (4) "Pilot program" means the gateway doctor pilot
1-20 program established under this subchapter.
1-21 Sec. 412.062. ESTABLISHMENT OF PILOT PROGRAM; PARTICIPATION.
1-22 (a) The office and the Research and Oversight Council on Workers'
1-23 Compensation jointly shall develop and implement a pilot program
1-24 under which medical benefits are provided to certain state
2-1 employees who sustain compensable injuries through the use of one
2-2 or more health care delivery networks.
2-3 (b) The office and the council jointly shall select a
2-4 limited number of state agencies to participate in the pilot
2-5 program. A state agency selected for participation under this
2-6 section is required to participate in the pilot program.
2-7 Sec. 412.063. PILOT PROGRAM ELEMENTS. (a) The office and
2-8 the council shall establish the pilot program as a loss control
2-9 program designed to determine whether the state may better control
2-10 the costs associated with the state employee workers' compensation
2-11 program operated under Chapter 501 by generating savings and more
2-12 efficient delivery of health care services through contracts with
2-13 health care delivery networks.
2-14 (b) In developing the pilot program, the office and the
2-15 council shall, to the extent possible, design the pilot program in
2-16 a manner that:
2-17 (1) provides state employees and the management of
2-18 participating state agencies the opportunity for input regarding:
2-19 (A) the health care practitioners and providers
2-20 used by the pilot program; and
2-21 (B) return-to-work coordination appropriate for
2-22 the pilot program;
2-23 (2) enhances the delivery of medical benefits to state
2-24 employees employed by participating state agencies by providing
2-25 better health care and faster access to that care;
2-26 (3) allows state employees access to networks of
2-27 physicians and chiropractors that are effectively monitored for
3-1 appropriate credentials, provision of quality care, enhancement of
3-2 the return to work of injured employees, and cost-effective
3-3 outcomes; and
3-4 (4) enables the state to determine whether extension
3-5 of the use of a health care delivery network and gateway doctors
3-6 would decrease direct costs associated with the operation of the
3-7 state employee workers' compensation program.
3-8 Sec. 412.064. REPORT. Not later than February 1 of each
3-9 odd-numbered year, the office and the council shall submit to the
3-10 legislature a written report concerning the effectiveness of the
3-11 pilot program in reducing the costs to the state associated with
3-12 the provision of medical benefits to employees of participating
3-13 state agencies.
3-14 Sec. 412.065. RULES; CONTRACTS. The office and the council
3-15 may adopt rules and enter into contracts as necessary or
3-16 appropriate to implement this subchapter.
3-17 SECTION 2. Section 501.002, Labor Code, is amended to read as
3-18 follows:
3-19 Sec. 501.002. APPLICATION OF GENERAL WORKERS' COMPENSATION
3-20 LAWS; LIMIT ON ACTIONS AND DAMAGES. (a) The following provisions
3-21 of Subtitles A and B apply to and are included in this chapter
3-22 except to the extent that they are inconsistent with this chapter:
3-23 (1) Chapter 401, other than Section 401.012 defining
3-24 "employee";
3-25 (2) Chapter 402;
3-26 (3) Chapter 403, other than Sections 403.001-403.005;
3-27 (4) [Chapter 405;]
4-1 [(5)] Subchapters B and D through H, Chapter 406,
4-2 other than Sections 406.071(a), 406.073, and 406.075;
4-3 (5) [(6)] Chapter 408, other than Sections 408.001(b)
4-4 and (c);
4-5 (6) [(7)] Chapters 409 and 410;
4-6 (7) [(8)] Subchapters A and G, Chapter 411, other than
4-7 Sections 411.003 and 411.004;
4-8 (8) [(9)] Chapters 412-417; and
4-9 (9) [(10)] Chapter 451.
4-10 (b) Notwithstanding Subsection (a), Sections 408.022,
4-11 408.023, 408.024, and 408.028(b) do not apply to a workers'
4-12 compensation claim brought by an employee of a state agency
4-13 participating in the pilot program established under Subchapter G,
4-14 Chapter 412.
4-15 (c) For the purposes of this chapter and Chapter 451, the
4-16 individual state agency shall be considered the employer.
4-17 (d) [(c)] For the purpose of applying the provisions listed
4-18 by Subsection (a) to this chapter, "insurer" or "employer" means
4-19 "state," "office," "director," or "state agency," as applicable.
4-20 (e) [(d)] Neither this chapter nor Subtitle A authorizes a
4-21 cause of action or damages against the state, a state agency, or an
4-22 employee of the state beyond the actions and damages authorized by
4-23 Chapter 101, Civil Practice and Remedies Code.
4-24 (f) [(e)] For the purposes of this chapter and Chapter 451,
4-25 the adjutant general is considered the employer of a member of the
4-26 state military forces while engaged in authorized training or duty.
4-27 SECTION 3. Subchapter B, Chapter 501, Labor Code, is amended
5-1 by adding Section 501.027 to read as follows:
5-2 Sec. 501.027. USE OF HEALTH CARE DELIVERY NETWORK REQUIRED.
5-3 (a) To receive medical benefits under this chapter, an employee of
5-4 a state agency participating in the pilot program established under
5-5 Subchapter G, Chapter 412, is required to use the services of a
5-6 gateway doctor or specialist who is a participating member of a
5-7 health care delivery network implemented under that subchapter. The
5-8 employee is entitled to select the employee's initial treating
5-9 doctor from the list of gateway doctors provided under Subsection
5-10 (b).
5-11 (b) The board shall periodically provide employees of
5-12 affected agencies with a list of health care practitioners who are
5-13 gateway doctors or specialists participating as members of
5-14 appropriate health care delivery networks.
5-15 SECTION 4. (a) This Act takes effect September 1, 2001.
5-16 (b) Not later than December 1, 2001, the risk management
5-17 board and the board of directors of the Research and Oversight
5-18 Council on Workers' Compensation shall adopt rules to implement the
5-19 pilot program established under Chapter 412, Labor Code, as amended
5-20 by this Act.
5-21 (c) Chapters 412 and 501, Labor Code, as amended by this
5-22 Act, apply only to a claim for workers' compensation benefits based
5-23 on a compensable injury that occurs on or after January 1, 2002. A
5-24 claim based on a compensable injury that occurs before that date is
5-25 governed by the law in effect on the date that the compensable
5-26 injury occurred, and the former law is continued in effect for that
5-27 purpose.