By Brimer H.B. No. 1192
77R4993 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a gateway physician 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 PHYSICIAN 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 physician" means a physician who is a
1-13 member of a health care delivery network with which the state
1-14 contracts for the provision of services under the pilot program.
1-15 (3) "Health care delivery network" means a health care
1-16 delivery system under which health care services are provided by
1-17 specific health care practitioners under contract.
1-18 (4) "Pilot program" means the gateway physician pilot
1-19 program established under this subchapter.
1-20 Sec. 412.062. ESTABLISHMENT OF PILOT PROGRAM; PARTICIPATION.
1-21 (a) The office and the Research and Oversight Council on Workers'
1-22 Compensation jointly shall develop and implement a pilot program
1-23 under which medical benefits are provided to certain state
1-24 employees who sustain compensable injuries through the use of a
2-1 health care delivery network.
2-2 (b) The office and the council jointly shall select a
2-3 limited number of state agencies to participate in the pilot
2-4 program. A state agency selected for participation under this
2-5 section is required to participate in the pilot program.
2-6 Sec. 412.063. PILOT PROGRAM ELEMENTS. (a) The office and
2-7 the council shall establish the pilot program as a loss control
2-8 program designed to determine whether the state may better control
2-9 the costs associated with the state employee workers' compensation
2-10 program operated under Chapter 501 by generating savings and more
2-11 efficient delivery of health care services through contracts with
2-12 health care delivery networks.
2-13 (b) In developing the pilot program, the office and the
2-14 council shall, to the extent possible, design the pilot program in
2-15 a manner that:
2-16 (1) enhances the delivery of medical benefits to state
2-17 employees employed by participating state agencies by providing
2-18 better health care and faster access to that care; and
2-19 (2) enables the state to determine whether extension
2-20 of the use of a health care delivery network and gateway physicians
2-21 would decrease direct costs associated with the operation of the
2-22 state employee workers' compensation program.
2-23 Sec. 412.064. REPORT. Not later than February 1 of each
2-24 odd-numbered year, the office and the council shall submit to the
2-25 legislature a written report concerning the effectiveness of the
2-26 pilot program in reducing the costs to the state associated with
2-27 the provision of medical benefits to employees of participating
3-1 state agencies.
3-2 Sec. 412.065. RULES; CONTRACTS. The board and the board of
3-3 directors of the council may adopt rules and enter into contracts
3-4 as necessary or appropriate to implement this subchapter.
3-5 SECTION 2. Section 501.002, Labor Code, is amended to read as
3-6 follows:
3-7 Sec. 501.002. APPLICATION OF GENERAL WORKERS' COMPENSATION
3-8 LAWS; LIMIT ON ACTIONS AND DAMAGES. (a) The following provisions
3-9 of Subtitles A and B apply to and are included in this chapter
3-10 except to the extent that they are inconsistent with this chapter:
3-11 (1) Chapter 401, other than Section 401.012 defining
3-12 "employee";
3-13 (2) Chapter 402;
3-14 (3) Chapter 403, other than Sections 403.001-403.005;
3-15 (4) [Chapter 405;]
3-16 [(5)] Subchapters B and D through H, Chapter 406,
3-17 other than Sections 406.071(a), 406.073, and 406.075;
3-18 (5) [(6)] Chapter 408, other than Sections 408.001(b)
3-19 and (c);
3-20 (6) [(7)] Chapters 409 and 410;
3-21 (7) [(8)] Subchapters A and G, Chapter 411, other than
3-22 Sections 411.003 and 411.004;
3-23 (8) [(9)] Chapters 412-417; and
3-24 (9) [(10)] Chapter 451.
3-25 (b) Notwithstanding Subsection (a), Sections 408.022,
3-26 408.023, and 408.024 do not apply to a workers' compensation claim
3-27 brought by an employee of a state agency participating in the pilot
4-1 program established under Subchapter G, Chapter 412.
4-2 (c) For the purposes of this chapter and Chapter 451, the
4-3 individual state agency shall be considered the employer.
4-4 (d) [(c)] For the purpose of applying the provisions listed
4-5 by Subsection (a) to this chapter, "insurer" or "employer" means
4-6 "state," "office," "director," or "state agency," as applicable.
4-7 (e) [(d)] Neither this chapter nor Subtitle A authorizes a
4-8 cause of action or damages against the state, a state agency, or an
4-9 employee of the state beyond the actions and damages authorized by
4-10 Chapter 101, Civil Practice and Remedies Code.
4-11 (f) [(e)] For the purposes of this chapter and Chapter 451,
4-12 the adjutant general is considered the employer of a member of the
4-13 state military forces while engaged in authorized training or duty.
4-14 SECTION 3. Subchapter B, Chapter 501, Labor Code, is amended
4-15 by adding Section 501.027 to read as follows:
4-16 Sec. 501.027. USE OF HEALTH CARE DELIVERY NETWORK REQUIRED.
4-17 (a) To receive medical benefits under this chapter, an employee of
4-18 a state agency participating in the pilot program established under
4-19 Subchapter G, Chapter 412, is required to use the services of a
4-20 gateway physician or specialist who is a participating member of a
4-21 health care delivery network implemented under that subchapter. The
4-22 employee is entitled to select the employee's initial treating
4-23 doctor from the list of gateway physicians provided under
4-24 Subsection (b).
4-25 (b) The board shall periodically provide employees of
4-26 affected agencies with a list of health care practitioners who are
4-27 gateway physicians or specialists participating as members of
5-1 appropriate health care delivery networks.
5-2 SECTION 4. (a) This Act takes effect September 1, 2001.
5-3 (b) Not later than December 1, 2001, the risk management
5-4 board and the board of directors of the Research and Oversight
5-5 Council on Workers' Compensation shall adopt rules to implement the
5-6 pilot program established under Chapter 412, Labor Code, as amended
5-7 by this Act.
5-8 (c) Chapters 412 and 501, Labor Code, as amended by this
5-9 Act, apply only to a claim for workers' compensation benefits based
5-10 on a compensable injury that occurs on or after January 1, 2002. A
5-11 claim based on a compensable injury that occurs before that date is
5-12 governed by the law in effect on the date that the compensable
5-13 injury occurred, and the former law is continued in effect for that
5-14 purpose.