1-1 AN ACT
1-2 relating to the provision of workers' compensation benefits and to
1-3 the operation of the workers' compensation insurance system;
1-4 providing penalties.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 ARTICLE 1. APPROVED DOCTORS; MEDICAL REVIEW
1-7 SECTION 1.01. Subchapter B, Chapter 408, Labor Code, is
1-8 amended by amending Section 408.023 and adding Section 408.0231 to
1-9 read as follows:
1-10 Sec. 408.023. LIST OF APPROVED DOCTORS; DUTIES OF TREATING
1-11 DOCTORS. (a) The commission shall develop a list of doctors
1-12 licensed in this state who are approved to provide health care
1-13 services under this subtitle. Each doctor licensed in this state
1-14 on September 1, 2001 [January 1, 1993], is eligible to be included
1-15 on the commission's list of approved doctors if the doctor:
1-16 (1) registers with the commission in the manner
1-17 prescribed by commission rules; and
1-18 (2) complies with the requirements adopted by the
1-19 commission under this section.
1-20 (b) The commission by rule shall establish reasonable
1-21 requirements for doctors and health care providers financially
1-22 related to those doctors regarding training, impairment rating
1-23 testing, and disclosure of financial interests as required by
1-24 Section 413.041, and for monitoring of those doctors and health
2-1 care providers as provided by Sections 408.0231 and 413.0512. The
2-2 commission by rule shall provide a reasonable period, not to exceed
2-3 18 months after the adoption of rules under this section, for
2-4 doctors to comply with the registration and training requirements
2-5 of this subchapter. Except as otherwise provided by this section,
2-6 the requirements under this subsection apply to doctors and other
2-7 health care providers who:
2-8 (1) provide health care services as treating doctors;
2-9 (2) provide health care services as authorized by this
2-10 chapter;
2-11 (3) perform medical peer review under this subtitle;
2-12 (4) perform utilization review of medical benefits
2-13 provided under this subtitle; or
2-14 (5) provide health care services on referral from a
2-15 treating doctor, as provided by commission rule.
2-16 (c) The commission shall issue to a doctor who is approved
2-17 by the commission a certificate of registration. In determining
2-18 whether to issue a certificate of registration, the commission may
2-19 consider and condition its approval on any practice restrictions
2-20 applicable to the applicant that are relevant to services provided
2-21 under this subtitle. The commission may also consider the practice
2-22 restrictions of an applicant when determining appropriate sanctions
2-23 under Section 408.0231.
2-24 (d) A certificate of registration issued under this section
2-25 is valid, unless revoked, suspended, or revised, for the period
2-26 provided by commission rule and may be renewed on application to
2-27 the commission. The commission shall provide notice to each
3-1 doctor on the approved doctor list of the pending expiration of the
3-2 doctor's certificate of registration not later than the 60th day
3-3 before the date of expiration of the certificate [unless
3-4 subsequently deleted and not reinstated. The name of a doctor
3-5 shall be placed on the list of approved doctors when that doctor
3-6 becomes licensed in this state].
3-7 (e) Notwithstanding other provisions of this section, a [A]
3-8 doctor not licensed in this state but licensed in another state or
3-9 jurisdiction who treats employees or performs utilization review of
3-10 health care for an insurance carrier may apply for a certificate of
3-11 registration under this section [to the commission] to be included
3-12 on the commission's list of approved doctors.
3-13 (f) Except in an emergency or for immediate post-injury
3-14 medical care as defined by commission rule, or as provided by
3-15 Subsection (h) or (i), each doctor who performs functions under
3-16 this subtitle, including examinations under this chapter, must hold
3-17 a certificate of registration and be on the list of approved
3-18 doctors in order to perform services or receive payment for those
3-19 services.
3-20 (g) The commission by rule shall modify registration and
3-21 training requirements for doctors who infrequently provide health
3-22 care, who perform utilization review or peer review functions for
3-23 insurance carriers, or who participate in regional networks
3-24 established under this subchapter, as necessary to ensure that
3-25 those doctors are informed of the regulations that affect health
3-26 care benefit delivery under this subtitle.
3-27 (h) Notwithstanding Section 4(h), Article 21.58A, Insurance
4-1 Code, a utilization review agent that uses doctors to perform
4-2 reviews of health care services provided under this subtitle may
4-3 use doctors licensed by another state to perform the reviews, but
4-4 the reviews must be performed under the direction of a doctor
4-5 licensed to practice in this state.
4-6 (i) The commission may grant exceptions to the requirement
4-7 imposed under Subsection (f) as necessary to ensure that:
4-8 (1) employees have access to health care; and
4-9 (2) insurance carriers have access to evaluations of
4-10 an employee's health care and income benefit eligibility as
4-11 provided by this subtitle.
4-12 (j) The injured employee's treating doctor is responsible
4-13 for the efficient management of medical care as required by Section
4-14 408.025(c) and commission rules. The commission shall collect
4-15 information regarding:
4-16 (1) return-to-work outcomes;
4-17 (2) patient satisfaction; and
4-18 (3) cost and utilization of health care provided or
4-19 authorized by a treating doctor on the list of approved doctors.
4-20 (k) The commission may adopt rules to define the role of the
4-21 treating doctor and to specify outcome information to be collected
4-22 for a treating doctor.
4-23 Sec. 408.0231. MAINTENANCE OF LIST OF APPROVED DOCTORS;
4-24 SANCTIONS AND PRIVILEGES RELATING TO HEALTH CARE. (a) The
4-25 executive director shall delete from the list of approved doctors a
4-26 doctor:
4-27 (1) who fails to register with the commission as
5-1 provided by this chapter and commission rules;
5-2 (2) who is deceased;
5-3 (3) whose license to practice in this state is
5-4 revoked, suspended, or not renewed by the appropriate licensing
5-5 authority; or
5-6 (4) who requests to be removed from the list.
5-7 (b) The commission by rule shall establish criteria for:
5-8 (1) deleting or suspending a doctor from the list of
5-9 approved doctors;
5-10 (2) imposing sanctions on a doctor or an insurance
5-11 carrier as provided by this section;
5-12 (3) monitoring of utilization review agents, as
5-13 provided by a memorandum of understanding between the commission
5-14 and the Texas Department of Insurance; and
5-15 (4) authorizing increased or reduced utilization
5-16 review and preauthorization controls on a doctor.
5-17 (c) Rules adopted under Subsection (b) are in addition to,
5-18 and do not affect, the rules adopted under Section 415.023(b). The
5-19 criteria for deleting a doctor from the list or for recommending or
5-20 imposing sanctions may include anything the commission considers
5-21 relevant, including:
5-22 (1) a sanction [sanctions] of the doctor by the
5-23 commission for a violation [violations] of Chapter 413 or Chapter
5-24 415;
5-25 (2) a sanction [sanctions] by the Medicare or Medicaid
5-26 program for:
5-27 (A) substandard medical care;
6-1 (B) overcharging; [or]
6-2 (C) overutilization of medical services; or
6-3 (D) any other substantive noncompliance with
6-4 requirements of those programs regarding professional practice or
6-5 billing;
6-6 (3) evidence from the commission's medical records
6-7 that the applicable insurance carrier's utilization review
6-8 practices or the doctor's charges, fees, diagnoses, [or]
6-9 treatments, evaluations, or impairment ratings are substantially
6-10 different from those the commission finds to be fair and reasonable
6-11 based on either a single determination or a pattern of practice;
6-12 [and]
6-13 (4) a suspension or other relevant practice
6-14 restriction of the doctor's license by an [the] appropriate
6-15 licensing authority;
6-16 (5) professional failure to practice medicine or
6-17 provide health care, including chiropractic care, in an acceptable
6-18 manner consistent with the public health, safety, and welfare;
6-19 (6) findings of fact and conclusions of law made by a
6-20 court, an administrative law judge of the State Office of
6-21 Administrative Hearings, or a licensing or regulatory authority; or
6-22 (7) a criminal conviction.
6-23 (d) [(c)] The commission by rule shall establish procedures
6-24 under which [for] a doctor may [to] apply for:
6-25 (1) reinstatement to the list of approved doctors; or
6-26 (2) restoration of doctor practice privileges removed
6-27 by the commission based on sanctions imposed under this section.
7-1 (e) The commission shall act on a recommendation by the
7-2 medical advisor selected under Section 413.0511 and, after notice
7-3 and the opportunity for a hearing, may impose sanctions under this
7-4 section on a doctor or an insurance carrier or may recommend action
7-5 regarding a utilization review agent. The commission and the Texas
7-6 Department of Insurance shall enter into a memorandum of
7-7 understanding to coordinate the regulation of insurance carriers
7-8 and utilization review agents as necessary to ensure:
7-9 (1) compliance with applicable regulations; and
7-10 (2) that appropriate health care decisions are reached
7-11 under this subtitle and under Article 21.58A, Insurance Code.
7-12 (f) The sanctions the commission may recommend or impose
7-13 under this section include:
7-14 (1) reduction of allowable reimbursement;
7-15 (2) mandatory preauthorization of all or certain
7-16 health care services;
7-17 (3) required peer review monitoring, reporting, and
7-18 audit;
7-19 (4) deletion or suspension from the approved doctor
7-20 list and the designated doctor list;
7-21 (5) restrictions on appointment under this chapter;
7-22 (6) conditions or restrictions on an insurance carrier
7-23 regarding actions by insurance carriers under this subtitle in
7-24 accordance with the memorandum of understanding adopted between the
7-25 commission and the Texas Department of Insurance regarding Article
7-26 21.58A, Insurance Code; and
7-27 (7) mandatory participation in training classes or
8-1 other courses as established or certified by the commission.
8-2 SECTION 1.02. Subchapter E, Chapter 413, Labor Code, is
8-3 amended by amending Section 413.051 and adding Sections 413.0511,
8-4 413.0512, and 413.0513 to read as follows:
8-5 Sec. 413.051. CONTRACTS WITH REVIEW ORGANIZATIONS AND HEALTH
8-6 CARE PROVIDERS. (a) The commission may contract with a health care
8-7 provider, health care provider professional review organization, or
8-8 other entity to develop, maintain, or review medical policies or
8-9 fee guidelines or to review compliance with the medical policies or
8-10 fee guidelines.
8-11 (b) For purposes of review or resolution of a dispute as to
8-12 compliance with the medical policies or fee guidelines, the
8-13 commission may contract [only] with a health care provider, health
8-14 care provider professional review organization, or other entity
8-15 that includes in the review process health care practitioners who
8-16 are licensed in the category under review and are of the same field
8-17 or specialty as the category under review.
8-18 (c) The commission may contract with a health care provider,
8-19 health care provider professional review organization, or other
8-20 entity for medical consultant services, including:
8-21 (1) independent medical examinations;
8-22 (2) medical case reviews; or
8-23 (3) establishment of medical policies and fee
8-24 guidelines.
8-25 (d) The commission shall establish standards for contracts
8-26 under this section.
8-27 (e) For purposes of this section, "health care provider
9-1 professional review organization" includes an independent review
9-2 organization.
9-3 Sec. 413.0511. MEDICAL ADVISOR. (a) The commission shall
9-4 employ or contract with a medical advisor, who must be a doctor as
9-5 that term is defined by Section 401.011.
9-6 (b) The medical advisor shall make recommendations regarding
9-7 the adoption of rules to:
9-8 (1) develop, maintain, and review guidelines as
9-9 provided by Section 413.011, including rules regarding impairment
9-10 ratings;
9-11 (2) review compliance with those guidelines;
9-12 (3) regulate or perform other acts related to medical
9-13 benefits as required by the commission;
9-14 (4) impose sanctions or delete doctors from the
9-15 commission's list of approved doctors under Section 408.023 for:
9-16 (A) any reason described by Section 408.0231; or
9-17 (B) noncompliance with commission rules;
9-18 (5) impose conditions or restrictions as authorized by
9-19 Section 408.0231(f);
9-20 (6) receive, and share with the medical quality review
9-21 panel established under Section 413.0512, confidential information
9-22 from the Texas State Board of Medical Examiners, the Texas Board of
9-23 Chiropractic Examiners, or other occupational licensing boards
9-24 regarding disciplinary actions imposed on a physician,
9-25 chiropractor, or other type of doctor who applies for registration
9-26 or is registered with the commission on the list of approved
9-27 doctors; and
10-1 (7) determine minimal modifications to the
10-2 reimbursement methodology and model used by the Medicare system as
10-3 necessary to meet occupational injury requirements.
10-4 Sec. 413.0512. MEDICAL QUALITY REVIEW PANEL. (a) The
10-5 medical advisor shall establish a medical quality review panel of
10-6 health care providers to assist the medical advisor in performing
10-7 the duties required under Section 413.0511. The panel is
10-8 independent of the medical advisory committee created under Section
10-9 413.005 and is not subject to Chapter 2110, Government Code.
10-10 (b) The Texas State Board of Medical Examiners and the Texas
10-11 Board of Chiropractic Examiners, with input from their respective
10-12 professional associations, shall develop lists of physicians and
10-13 chiropractors licensed by those agencies who have demonstrated
10-14 experience in workers' compensation or utilization review. The
10-15 medical advisor shall consider appointing some of the members of
10-16 the medical quality review panel from the names on those lists.
10-17 The medical advisor shall also consider nominations for the panel
10-18 made by labor, business, and insurance organizations.
10-19 (c) The medical quality review panel shall recommend to the
10-20 medical advisor:
10-21 (1) appropriate action regarding doctors, other health
10-22 care providers, insurance carriers, and utilization review agents;
10-23 and
10-24 (2) the addition or deletion of doctors from the list
10-25 of approved doctors under Section 408.023 or the list of designated
10-26 doctors established under Section 408.122.
10-27 (d) A person who serves on the medical quality review panel
11-1 is not liable in a civil action for an act performed in good faith
11-2 as a member of the panel and is entitled to the same protections
11-3 afforded a commission member under Section 402.010.
11-4 (e) The actions of a person serving on the medical quality
11-5 review panel do not constitute utilization review and are not
11-6 subject to Article 21.58A, Insurance Code.
11-7 Sec. 413.0513. CONFIDENTIALITY REQUIREMENTS. (a) Information
11-8 maintained by or on behalf of the commission under Section 413.0511
11-9 or 413.0512, and that is confidential under law, may not be
11-10 disclosed under Section 413.0511 or 413.0512 except:
11-11 (1) in a criminal proceeding;
11-12 (2) in a hearing conducted by or on behalf of the
11-13 commission;
11-14 (3) in a hearing conducted by another licensing or
11-15 regulatory authority, as provided in the interagency agreement; or
11-16 (4) on a finding of good cause in an administrative or
11-17 judicial proceeding involving the enforcement of this subtitle or
11-18 in a disciplinary action under this subtitle.
11-19 (b) Confidential information developed by or on behalf of
11-20 the commission under Section 413.0512 is not subject to discovery
11-21 or court subpoena in any action other than:
11-22 (1) an action to enforce this subtitle brought by the
11-23 commission, an appropriate licensing or regulatory agency, or an
11-24 appropriate enforcement authority; or
11-25 (2) a criminal proceeding.
11-26 SECTION 1.03. (a) The Texas Workers' Compensation Commission
11-27 shall adopt rules as required by Chapter 408, Labor Code, as
12-1 amended by this article, not later than February 1, 2002.
12-2 (b) A doctor is not required to hold a certificate of
12-3 registration issued under Section 408.023, Labor Code, as amended
12-4 by this article, to perform medical services under Subtitle A,
12-5 Title 5, Labor Code, before the date provided by commission rules
12-6 adopted to implement that section.
12-7 ARTICLE 2. MEDICAL NETWORK PARTICIPATION OPTION
12-8 SECTION 2.01. Subchapter B, Chapter 408, Labor Code, is
12-9 amended by adding Sections 408.0221, 408.0222, and 408.0223 to read
12-10 as follows:
12-11 Sec. 408.0221. REGIONAL HEALTH CARE DELIVERY NETWORKS;
12-12 ADVISORY COMMITTEE. (a) In this section:
12-13 (1) "Advisory committee" means the Health Care Network
12-14 Advisory Committee.
12-15 (2) "Regional network" means a regional workers'
12-16 compensation health care delivery network established by the
12-17 commission under this section.
12-18 (b) The regional networks established under this section
12-19 shall be fee-for-service networks designed to improve the quality
12-20 and reduce the cost of health care, with active health care
12-21 management and monitoring and a full range of health care services
12-22 under contract as considered feasible under the feasibility study
12-23 required under Subsection (d).
12-24 (c) The Health Care Network Advisory Committee is
12-25 established to advise the commission on the implementation of this
12-26 section and Section 408.0222. Members of the advisory committee
12-27 are appointed by the governor for staggered two-year terms, with
13-1 the membership as follows:
13-2 (1) three employee representatives recommended by a
13-3 recognized statewide labor federation;
13-4 (2) three employer representatives;
13-5 (3) three ex officio insurance carrier
13-6 representatives, with one member representing state agencies, one
13-7 member representing the Texas Workers' Compensation Insurance Fund,
13-8 and one member representing a voluntary market insurance carrier;
13-9 (4) three ex officio health care provider
13-10 representatives;
13-11 (5) one ex officio independent actuarial expert; and
13-12 (6) the commission's medical advisor, who shall serve
13-13 as chair of the advisory committee.
13-14 (d) The commission, on behalf of the advisory committee
13-15 established under this section, shall establish and, through
13-16 competitive procurement, contract with regional networks for the
13-17 provision of health care under this subtitle. The commission
13-18 shall, through competitive procurement, contract with one or more
13-19 entities to determine the feasibility of, develop, and evaluate the
13-20 regional networks established under this section. Those entities
13-21 shall also recommend to the advisory committee appropriate network
13-22 standards and application requirements and assist the advisory
13-23 committee during the procurement process. The provision of health
13-24 care under this subtitle shall not apply to prescription medication
13-25 or services as defined by Section 401.011(19), Subsection (e),
13-26 Labor Code.
13-27 (e) The advisory committee shall make recommendations to the
14-1 commission regarding:
14-2 (1) the development of the standards by which health
14-3 care services are provided through regional networks;
14-4 (2) regional network application requirements and
14-5 fees;
14-6 (3) contract proposals;
14-7 (4) the feasibility of establishing one or more
14-8 regional networks using a phased implementation and evaluation
14-9 process;
14-10 (5) the use of consultants as necessary to assist the
14-11 commission in the procurement of regional network contracts; and
14-12 (6) the selection of administrators to build and
14-13 manage the regional networks and to report on their progress.
14-14 (f) The advisory committee shall gather information from
14-15 other entities, including the Research and Oversight Council on
14-16 Workers' Compensation, the Texas Health Care Information Council,
14-17 the Texas Department of Insurance, the Texas Department of Health,
14-18 and the Employees Retirement System of Texas.
14-19 (g) The standards adopted for preferred provider networks
14-20 under Article 3.70-3C, Insurance Code, as added by Chapter 1024,
14-21 Acts of the 75th Legislature, Regular Session, 1997, apply as
14-22 minimum standards for regional health care delivery networks
14-23 created under this section and are adopted by reference in this
14-24 section except to the extent they are inconsistent with this
14-25 subtitle. The advisory committee may also recommend additional
14-26 standards, including standards that require:
14-27 (1) for each geographic region, access to an adequate
15-1 number of health care providers and treating doctors in each
15-2 appropriate health care discipline and the professional specialties
15-3 within those disciplines and a viable network through:
15-4 (A) the use of economic profiling as described
15-5 by Article 3.70-3C, Insurance Code, as added by Chapter 1024, Acts
15-6 of the 75th Legislature, Regular Session, 1997; and
15-7 (B) limitations on the number of providers, as
15-8 provided by that article;
15-9 (2) the ability of an employee to receive treatment by
15-10 a regional network provider within a reasonable amount of time of
15-11 the regional network's knowledge of the need or request for
15-12 treatment and within a reasonable travel distance for the employee;
15-13 (3) a reasonable effort by the regional network to
15-14 attract health care providers who reflect the ethnic and cultural
15-15 background of the regional employee population;
15-16 (4) the availability of board-certified occupational
15-17 medicine specialists to provide expertise on disability management
15-18 and prevention and treatment of occupational injuries and
15-19 illnesses;
15-20 (5) accreditation of the regional networks or a
15-21 commitment to seek accreditation from a nationally recognized
15-22 organization such as the American Accreditation HealthCare
15-23 Commission or the National Committee for Quality Assurance;
15-24 (6) the use of strict credentialing criteria by
15-25 regional networks in the selection and deselection of its health
15-26 care providers, including verification that the provider:
15-27 (A) is on the commission's list of approved
16-1 doctors, if the provider is required to be on that list;
16-2 (B) has not, at the time of selection or
16-3 deselection, been sanctioned or made subject to additional
16-4 utilization review requirements by the commission;
16-5 (C) is not, at the time of selection or
16-6 deselection, subject to sanctions or substantive practice
16-7 restrictions imposed by the provider's licensing authority;
16-8 (D) has or is able to obtain practice
16-9 privileges, if required, at a participating hospital; and
16-10 (E) is covered by professional liability
16-11 insurance coverage as required by the regional network contract;
16-12 (7) satisfactory evidence of the regional network's
16-13 ability to comply with any financial requirements and ensure
16-14 delivery of services;
16-15 (8) compliance with ongoing training and educational
16-16 requirements established by the commission;
16-17 (9) the use of nationally recognized, scientifically
16-18 valid, and outcome-based treatment standards as guidelines for
16-19 health care;
16-20 (10) disclosure of the availability of interpreter
16-21 services as appropriate for the evaluation and treatment of
16-22 employees;
16-23 (11) timely and accurate reporting of data to
16-24 appropriately manage and determine the effectiveness of the
16-25 regional network in reducing medical costs and ensuring quality of
16-26 care;
16-27 (12) a process for reconsideration of medical
17-1 necessity denials and dispute resolution within the regional
17-2 network; and
17-3 (13) a process for reviewing requests for a change in
17-4 treating doctors made under Section 408.0222(s).
17-5 (h) The advisory committee and the Research and Oversight
17-6 Council on Workers' Compensation shall develop evaluation standards
17-7 and specifications as necessary to implement a regional network
17-8 report card. The commission shall ensure that the report card is
17-9 published and available for inspection. The commission may procure
17-10 services as necessary to produce the report card. The report card,
17-11 at a minimum, must be based on contracted reviews and must include
17-12 a risk-adjusted evaluation of:
17-13 (1) employee access to care;
17-14 (2) coordination of care and return to work;
17-15 (3) communication among system participants;
17-16 (4) return-to-work outcomes;
17-17 (5) health-related outcomes;
17-18 (6) employee, health care provider, employer, and
17-19 insurance carrier satisfaction;
17-20 (7) disability and re-injury prevention;
17-21 (8) appropriate clinical care;
17-22 (9) health care costs;
17-23 (10) utilization of health care; and
17-24 (11) statistical outcomes of medical dispute
17-25 resolution provided by independent review organizations.
17-26 (i) The regional network administrators shall report
17-27 quarterly to the commission and the advisory committee on the
18-1 progress of implementing the regional networks and shall submit
18-2 consolidated annual reports. The Research and Oversight Council on
18-3 Workers' Compensation shall report to the legislature by January 1
18-4 of each odd-numbered year on the status of the implementation of
18-5 regional networks under this section.
18-6 (j) The commission shall ensure that regional network
18-7 contracts provide that insurance carriers have reasonable rights to
18-8 conduct audits under this subsection. Insurance carriers
18-9 participating in the regional network shall be allowed the
18-10 opportunity for consolidated audits of the regional networks.
18-11 (k) The cost of assessing the feasibility of, developing,
18-12 and evaluating the regional networks created under this section
18-13 shall be funded through an assessment on the subsequent injury fund
18-14 established under Section 403.006. This cost may not exceed a
18-15 total of $1.5 million for the regional networks. The cost of
18-16 ongoing regional network administration and management services
18-17 shall be included in the fees for health care services paid by
18-18 insurance carriers participating in the regional network.
18-19 (l) Based on the information compiled for the annual reports
18-20 submitted under Subsection (i), the regional network
18-21 administrators, in consultation with actuaries with whom the
18-22 regional networks contract, shall determine on an annual basis any
18-23 cost savings to the operation of the workers' compensation system
18-24 derived from the use of the regional networks and the amount of
18-25 those savings.
18-26 Sec. 408.0222. PARTICIPATION IN REGIONAL NETWORK; SELECTION
18-27 OF DOCTOR WITHIN REGIONAL NETWORK; BENEFIT INCENTIVES. (a) An
19-1 insurance carrier or a self-insurer certified to provide workers'
19-2 compensation coverage in this state may elect to participate or not
19-3 participate, by contract, in a regional network established under
19-4 Section 408.0221. A public employer covered under Subtitle C of
19-5 this title, other than an employer covered under Chapter 504, is
19-6 required to participate in a regional network established under
19-7 Section 408.0221. An insurance carrier who elects to participate
19-8 in regional networks agrees to abide by the terms of the regional
19-9 network contracts between the commission and the regional networks.
19-10 (b) An insurance carrier may limit its election to
19-11 participate in a regional network established under Section
19-12 408.0221 to a particular employer or a particular region of this
19-13 state. This subsection expires January 1, 2006.
19-14 (c) A health care provider participating in a regional
19-15 network established under Section 408.0221 may perform only those
19-16 procedures that are within the scope of the practice for which the
19-17 health care provider is licensed.
19-18 (d) An employee may elect to participate or not participate
19-19 in a regional network established under Section 408.0221. Only an
19-20 employee covered by an insurance carrier who has elected to
19-21 participate in a regional network established under Section
19-22 408.0221 may elect to participate in that regional network. An
19-23 eligible employee may elect to participate or not participate in
19-24 the regional network for each compensable injury sustained by the
19-25 employee. Except as provided by this section, the employee's
19-26 election to participate in the network is effective for all medical
19-27 care related to that injury. The advisory committee shall make
20-1 recommendations and the commission, by rule, shall establish:
20-2 (1) the form and manner by which an employee:
20-3 (A) receives notice of the employee's rights; or
20-4 (B) documents the employee's election or
20-5 rescission of a prior election;
20-6 (2) the timing and recovery of a payment of enhanced
20-7 benefits; and
20-8 (3) other related issues.
20-9 (e) Except as provided by Subsection (f), an employee shall
20-10 make the election described by this section during an
20-11 employer-designated enrollment period or at the time of employment.
20-12 An employee who has elected to participate in the network may
20-13 rescind that election at any time before the earlier of:
20-14 (1) the date on which the employee begins to receive
20-15 enhanced income benefits under Subsection (m); or
20-16 (2) the 14th day after the date on which the employee
20-17 receives health care from a network health care provider for that
20-18 injury.
20-19 (f) An employee may elect to participate in a regional
20-20 network established under Section 408.0221 at any time with the
20-21 insurance carrier's agreement. An employee is not bound by an
20-22 election to participate in a regional network made under
20-23 Subsection (d) or this subsection if:
20-24 (1) the insurance carrier waives the election;
20-25 (2) the commission invalidates the election based on a
20-26 determination of coercion;
20-27 (3) the employee relocates to an area outside of the
21-1 regional network's service area, and the regional network is not
21-2 able to identify alternate network providers to provide health care
21-3 services reasonable for the employee's medical condition; or
21-4 (4) notwithstanding Subsection (n), the commission
21-5 sets aside the employee's election based on a finding that:
21-6 (A) the worker was bound by an election to
21-7 participate in the network;
21-8 (B) the carrier disputes the compensability of
21-9 the employee's injury; and
21-10 (C) network health care providers are unwilling
21-11 to provide health care to the employee pending the resolution of
21-12 the dispute.
21-13 (g) An insurance carrier who elects to participate in a
21-14 regional network established under Section 408.0221 shall provide
21-15 each employer who obtains coverage through the insurance carrier
21-16 with adequate information about the regional network to share with
21-17 the employer's employees. Before an employee makes an election
21-18 under this section to participate in a regional network, the
21-19 employer shall provide the employee with:
21-20 (1) a complete, plain-language description of the
21-21 regional network's services, restrictions, and benefits, including
21-22 a description of the enhanced income benefits that may be due; and
21-23 (2) access to the most recent:
21-24 (A) list of doctors available through the
21-25 regional network; and
21-26 (B) regional network report card developed under
21-27 Section 408.0221.
22-1 (h) An employer shall not discharge, subject to disciplinary
22-2 action, or take an adverse employment action against an employee
22-3 who elects not to participate in a regional network created under
22-4 Section 408.0221 if the employer's action would not have occurred
22-5 in the absence of the employee's election not to participate.
22-6 (i) An employee may bring suit against an employer for
22-7 violation of Subsection (h) if:
22-8 (1) the employee gives written notice of intent to
22-9 bring suit to the employer within 60 days of the alleged violation;
22-10 and
22-11 (2) the employer does not reinstate the employee and
22-12 pay actual wages lost and reasonable attorney's fees incurred due
22-13 to the employer's action within 60 days of notification of the
22-14 employee's intent to bring suit.
22-15 (j) The employee must bring suit for an employer's violation
22-16 of Subsection (h) within one year of the alleged violation. A suit
22-17 under this section may be brought in the county in which:
22-18 (1) the plaintiff resides;
22-19 (2) the plaintiff was employed; or
22-20 (3) the defendant's primary place of business is
22-21 located.
22-22 (k) If the employee prevails in an action under Subsection
22-23 (i), the employee may recover:
22-24 (1) lost wages;
22-25 (2) reinstatement of front pay as equitable relief in
22-26 lieu of reinstatement;
22-27 (3) reasonable attorney's fees; and
23-1 (4) court costs.
23-2 (l) A suit under this section is the exclusive remedy for
23-3 violation of Subsection (h), and the provisions of Chapter 451 do
23-4 not apply to such a violation. Parties may not maintain an action
23-5 under Rule 42, Texas Rules of Civil Procedure.
23-6 (m) An employee who elects to participate in a regional
23-7 network created under Section 408.0221 shall receive:
23-8 (1) notwithstanding Section 408.082(c), income
23-9 benefits from the date disability begins if the disability lasts
23-10 two weeks or longer; and
23-11 (2) notwithstanding Section 408.061, an increased
23-12 maximum weekly benefit of up to 150 percent of the state average
23-13 weekly wage for temporary income benefits.
23-14 (n) Except for emergency care, or as otherwise provided by
23-15 this section, an employee who elects to participate in a regional
23-16 network shall receive medical treatment, including referrals, from
23-17 health care providers within the regional network. An employee or
23-18 an employee's treating doctor may use a health care provider
23-19 outside of the regional network with the approval of the regional
23-20 network for good cause consistent with the regional network
23-21 contract. If medically necessary services are not available
23-22 through regional network health care providers, the regional
23-23 network must, on the request of a regional network health care
23-24 provider, within a reasonable time allow a referral to a
23-25 nonregional network health care provider and shall fully reimburse
23-26 the nonregional network physician or provider at the rate provided
23-27 by the commission fee guidelines or an agreed rate. For purposes of
24-1 this subsection, "emergency care" has the meaning assigned by
24-2 Section 2(g), Texas Health Maintenance Organization Act (Article
24-3 20A.02, Vernon's Texas Insurance Code).
24-4 (o) A health care provider who participates in a regional
24-5 network created under Section 408.0221 shall be reimbursed and be
24-6 subject to utilization review as provided by the regional network
24-7 contract. The insurance carrier is responsible for payment of
24-8 regional network providers as provided by the contract with the
24-9 regional network. A non-network provider who does not obtain the
24-10 approval of the regional network to provide services may not be
24-11 reimbursed by the insurance carrier, unless the provider requested
24-12 and received verification from the insurance carrier that the
24-13 employee was not bound by a network election under Subsection (e).
24-14 (p) To resolve an issue regarding the necessity or the
24-15 appropriateness of care, or referrals to nonregional network
24-16 physicians or providers, an employee or an employee's treating
24-17 doctor may request a review by an independent review organization
24-18 under Section 413.031(d).
24-19 (q) An employee who elects to participate in a regional
24-20 network established under Section 408.0221 shall select an initial
24-21 treating doctor within the regional network as provided by the
24-22 regional network contract. An employee who requests to change
24-23 treating doctors within the regional network is not subject to
24-24 Section 408.022. At the sole discretion of the regional network,
24-25 an employee may select a treating doctor outside of the regional
24-26 network if:
24-27 (1) the employee has a preexisting relationship with a
25-1 doctor who maintains the employee's medical records and has a
25-2 documented history of treatment before the date of injury; and
25-3 (2) that doctor agrees in writing to abide by the
25-4 rules, terms, and conditions of the regional network contract,
25-5 including an agreement to refer the employee within the regional
25-6 network for services available through the regional network.
25-7 (r) An employee is subject to the selection of doctor,
25-8 change of doctor, and other medical benefit and income benefit
25-9 requirements established under this chapter and Chapter 413 if an
25-10 employee:
25-11 (1) elects not to participate in a regional network
25-12 established under Section 408.0221; or
25-13 (2) is employed by an employer for whom the insurance
25-14 carrier has not elected to participate in a regional network
25-15 established under Section 408.0221.
25-16 (s) An employee may change treating doctors within the
25-17 regional network established under Section 408.0221 in which the
25-18 employee is participating in accordance with the regional network
25-19 contract and is entitled to:
25-20 (1) make one change from the initial treating doctor
25-21 to an alternate treating doctor within the regional network unless
25-22 the change is for the purpose of securing a new impairment rating
25-23 or new determination of maximum medical improvement; and
25-24 (2) request additional changes of the treating doctor
25-25 in the manner provided by the regional network contract.
25-26 (t) An employee or insurance carrier may request that the
25-27 commission order an examination under Section 408.0041 if an
26-1 employee has received conflicting impairment ratings or
26-2 determinations of maximum medical improvement from more than one
26-3 treating doctor.
26-4 (u) For purposes of this section, the following is not a
26-5 selection of an alternate doctor in a regional network established
26-6 under Section 408.0221:
26-7 (1) a referral made by the doctor chosen by the
26-8 employee if the referral is medically reasonable and necessary;
26-9 (2) the receipt of services ancillary to surgery;
26-10 (3) the obtaining of a second opinion only on the
26-11 appropriateness of the diagnosis or treatment;
26-12 (4) the selection of a doctor because the original
26-13 doctor:
26-14 (A) dies;
26-15 (B) retires; or
26-16 (C) becomes unavailable or unable to provide
26-17 medical care to the employee; or
26-18 (5) a change of doctor required because of a change of
26-19 residence by the employee.
26-20 Sec. 408.0223. INSURANCE CARRIER NETWORKS. (a) In this
26-21 section, "insurance carrier network" means a voluntary workers'
26-22 compensation health care delivery network established by an
26-23 insurance carrier. The term does not include a regional network
26-24 established under Section 408.0221.
26-25 (b) This subtitle does not prohibit an insurance carrier,
26-26 whether doing business as an individual carrier or as a group, from
26-27 participating in or maintaining voluntary insurance carrier
27-1 networks if those voluntary insurance carrier networks allow
27-2 selection of doctors as provided by Section 408.022.
27-3 (c) This subtitle does not prohibit an insurance carrier
27-4 from concurrently participating in an insurance carrier network and
27-5 a regional network established under Section 408.0221.
27-6 (d) The standards adopted for preferred provider networks
27-7 under Article 3.70-3C, Insurance Code, as added by Chapter 1024,
27-8 Acts of the 75th Legislature, Regular Session, 1997, and as
27-9 subsequently amended, apply as minimum standards for insurance
27-10 carrier networks and are adopted by reference in this section
27-11 except to the extent those standards are inconsistent with this
27-12 subtitle. The advisory committee, defined in Section 408.0221, may
27-13 recommend additional standards for insurance carrier networks that
27-14 are no more stringent than the additional standards that the
27-15 advisory committee recommends for regional health care delivery
27-16 networks pursuant to Section 408.0221(g).
27-17 (e) The Texas Workers' Compensation Commission shall adopt
27-18 rules, as necessary, to implement additional standards for
27-19 insurance carrier networks.
27-20 SECTION 2.02. (a) The Texas Workers' Compensation Commission
27-21 shall adopt rules as required by Chapter 408, Labor Code, as
27-22 amended by this article, not later than October 1, 2002.
27-23 (b) The Texas Workers' Compensation Commission shall convene
27-24 the first meeting of the Health Care Network Advisory Committee
27-25 established under Section 408.0221, Labor Code, as added by this
27-26 article, not later than October 1, 2001.
27-27 (c) Unless determined to be unfeasible, the Texas Workers'
28-1 Compensation Commission shall contract for regional workers'
28-2 compensation health care delivery networks under Section 408.0221,
28-3 Labor Code, as added by this article, not later than December 31,
28-4 2002.
28-5 (d) Section 408.0222, Labor Code, as added by this article,
28-6 as that section affects workers' compensation benefits an employee
28-7 may receive for participating in a regional network under Section
28-8 408.0221, Labor Code, as added by this article, takes effect on the
28-9 certification by the Texas Workers' Compensation Commission that
28-10 the regional network is operational.
28-11 ARTICLE 3. RETURN-TO-WORK REPORTING AND SERVICES
28-12 SECTION 3.01. Section 409.005, Labor Code, is amended to
28-13 read as follows:
28-14 Sec. 409.005. REPORT OF INJURY; MODIFIED DUTY PROGRAM
28-15 NOTICE; ADMINISTRATIVE VIOLATION. (a) An employer shall report to
28-16 the employer's insurance carrier if:
28-17 (1) an injury results in the absence of an employee of
28-18 that employer from work for more than one day; or
28-19 (2) an employee of the employer notifies that employer
28-20 of an occupational disease under Section 409.001.
28-21 (b) The report under Subsection (a) must be made not later
28-22 than the eighth day after:
28-23 (1) the employee's absence from work for more than one
28-24 day due to an injury; or
28-25 (2) the day on which the employer receives notice
28-26 under Section 409.001 that the employee has contracted an
28-27 occupational disease.
29-1 (c) The employer shall deliver a written copy of the report
29-2 under Subsection (a) to the injured employee at the time that the
29-3 report is made to the insurance carrier.
29-4 (d) The insurance carrier shall file the report of the
29-5 injury on behalf of the policyholder. Except as provided by
29-6 Subsection (e), the insurance carrier must electronically file the
29-7 report with the commission not later than the seventh day after the
29-8 date on which the carrier receives the report from the employer.
29-9 (e) The executive director may waive the electronic filing
29-10 requirement under Subsection (d) and allow an insurance carrier to
29-11 mail or deliver the report to the commission not later than the
29-12 seventh day after the date on which the carrier receives the report
29-13 from the employer.
29-14 (f) A report required under this section may not be
29-15 considered to be an admission by or evidence against an employer or
29-16 an insurance carrier in a proceeding before the commission or a
29-17 court in which the facts set out in the report are contradicted by
29-18 the employer or insurance carrier.
29-19 (g) In addition to any information required under Subsection
29-20 (h), the report provided to the injured employee under Subsection
29-21 (c) must contain a summary written in plain language of the
29-22 employee's statutory rights and responsibilities under this
29-23 subtitle.
29-24 (h) The commission may adopt rules relating to:
29-25 (1) the information that must be contained in a report
29-26 required under this section, including the summary of rights and
29-27 responsibilities required under Subsection (g); and
30-1 (2) the development and implementation of an
30-2 electronic filing system for injury reports under this section.
30-3 (i) An employer and insurance carrier shall file subsequent
30-4 reports as required by commission rule.
30-5 (j) The employer shall, on the written request of the
30-6 employee, a doctor, the insurance carrier, or the commission,
30-7 notify the employee, the employee's treating doctor if known to the
30-8 employer, and the insurance carrier of the existence or absence of
30-9 opportunities for modified duty or a modified duty return-to-work
30-10 program available through the employer. If those opportunities or
30-11 that program exists, the employer shall identify the employer's
30-12 contact person and provide other information to assist the doctor,
30-13 the employee, and the insurance carrier to assess modified duty or
30-14 return-to-work options.
30-15 (k) This section does not prohibit the commission from
30-16 imposing requirements relating to return-to-work under other
30-17 authority granted to the commission in this subtitle.
30-18 (l) A person commits a violation if the person fails to
30-19 comply with this section unless good cause exists. A violation
30-20 under this subsection is a Class D administrative violation.
30-21 SECTION 3.02. Subchapter B, Chapter 413, Labor Code, is
30-22 amended by adding Section 413.021 to read as follows:
30-23 Sec. 413.021. RETURN-TO-WORK COORDINATION SERVICES. (a) An
30-24 insurance carrier shall, with the agreement of a participating
30-25 employer, provide the employer with return-to-work coordination
30-26 services as necessary to facilitate an employee's return to
30-27 employment. The insurance carrier shall notify the employer of the
31-1 availability of return-to-work coordination services. In offering
31-2 the services, insurance carriers and the commission shall target
31-3 employers without return-to-work programs and shall focus
31-4 return-to-work efforts on workers who begin to receive temporary
31-5 income benefits. These services may be offered by insurance
31-6 carriers in conjunction with the accident prevention services
31-7 provided under Section 411.061. Nothing in this section supersedes
31-8 the provisions of a collective bargaining agreement between an
31-9 employer and the employer's employees, and nothing in this section
31-10 authorizes or requires an employer to engage in conduct that would
31-11 otherwise be a violation of the employer's obligations under the
31-12 National Labor Relations Act (29 U.S.C. Section 151 et seq.), and
31-13 its subsequent amendments.
31-14 (b) Return-to-work coordination services under this section
31-15 may include:
31-16 (1) job analysis to identify the physical demands of a
31-17 job;
31-18 (2) job modification and restructuring assessments as
31-19 necessary to match job requirements with the functional capacity of
31-20 an employee; and
31-21 (3) medical or vocational case management to
31-22 coordinate the efforts of the employer, the treating doctor, and
31-23 the injured employee to achieve timely return to work.
31-24 (c) An insurance carrier is not required to provide physical
31-25 workplace modifications under this section and is not liable for
31-26 the cost of modifications made under this section to facilitate an
31-27 employee's return to employment.
32-1 (d) The commission shall use certified rehabilitation
32-2 counselors or other appropriately trained or credentialed
32-3 specialists to provide training to commission staff regarding the
32-4 coordination of return-to-work services under this section.
32-5 (e) The commission shall adopt rules necessary to collect
32-6 data on return-to-work outcomes to allow full evaluations of
32-7 successes and of barriers to achieving timely return to work after
32-8 an injury.
32-9 (f) The commission shall report twice annually to the
32-10 Research and Oversight Council on Workers' Compensation regarding
32-11 the implementation and outcome of the return-to-work initiatives
32-12 required by this section.
32-13 SECTION 3.03. The Texas Workers' Compensation Commission may
32-14 adopt rules as necessary to implement Sections 409.005(j) and
32-15 413.021, Labor Code, as added by this article, not earlier than
32-16 January 1, 2004.
32-17 ARTICLE 4. PREAUTHORIZATION, CONCURRENT REVIEW,
32-18 AND CERTIFICATION REQUIREMENTS
32-19 SECTION 4.01. Section 408.026, Labor Code, is amended to read
32-20 as follows:
32-21 Sec. 408.026. SPINAL SURGERY [SECOND OPINION]. [(a)] Except
32-22 in a medical emergency, an insurance carrier is liable for medical
32-23 costs related to spinal surgery only as provided by Section 413.014
32-24 and commission rules [if:]
32-25 [(1) before surgery, the employee obtains from a
32-26 doctor approved by the insurance carrier or the commission a second
32-27 opinion that concurs with the treating doctor's recommendation;]
33-1 [(2) the insurance carrier waives the right to an
33-2 examination or fails to request an examination before the 15th day
33-3 after the date of the notification that surgery is recommended; or]
33-4 [(3) the commission determines that extenuating
33-5 circumstances exist and orders payment for surgery].
33-6 [(b) The commission shall adopt rules necessary to ensure
33-7 that an examination required under this section is performed
33-8 without undue delay.]
33-9 SECTION 4.02. Section 413.014, Labor Code, is amended to read
33-10 as follows:
33-11 Sec. 413.014. PREAUTHORIZATION REQUIREMENTS; CONCURRENT
33-12 REVIEW AND CERTIFICATION OF HEALTH CARE. (a) In this section,
33-13 "investigational or experimental service or device" means a health
33-14 care treatment, service, or device for which there is early,
33-15 developing scientific or clinical evidence demonstrating the
33-16 potential efficacy of the treatment, service, or device but that is
33-17 not yet broadly accepted as the prevailing standard of care.
33-18 (b) The commission by rule shall specify which health care
33-19 treatments and services require express preauthorization or
33-20 concurrent review by the insurance carrier. Treatments and services
33-21 for a medical emergency do not require express preauthorization.
33-22 (c) The commission rules adopted under this section must
33-23 provide that preauthorization and concurrent review are required at
33-24 a minimum for:
33-25 (1) spinal surgery, as provided by Section 408.026;
33-26 (2) work-hardening or work-conditioning services
33-27 provided by a health care facility that is not credentialed by an
34-1 organization recognized by commission rules;
34-2 (3) inpatient hospitalization, including any procedure
34-3 and length of stay;
34-4 (4) outpatient or ambulatory surgical services, as
34-5 defined by commission rule; and
34-6 (5) any investigational or experimental services or
34-7 devices.
34-8 (d) [(b)] The insurance carrier is not liable for those
34-9 specified treatments and services requiring preauthorization unless
34-10 preauthorization is sought by the claimant or health care provider
34-11 and either obtained from the insurance carrier or ordered by the
34-12 commission.
34-13 (e) The commission may not prohibit an insurance carrier and
34-14 a health care provider from voluntarily discussing health care
34-15 treatment and treatment plans, either prospectively or
34-16 concurrently, and may not prohibit an insurance carrier from
34-17 certifying or agreeing to pay for health care consistent with those
34-18 agreements.
34-19 SECTION 4.03. Subchapter B, Chapter 413, Labor Code, is
34-20 amended by adding Section 413.0141 to read as follows:
34-21 Sec. 413.0141. INITIAL PHARMACEUTICAL COVERAGE. The
34-22 commission may by rule provide that an insurance carrier shall
34-23 provide for payment of specified pharmaceutical services sufficient
34-24 for the first seven days following the date of injury if the health
34-25 care provider requests and receives verification of insurance
34-26 coverage and a verbal confirmation of an injury from the employer
34-27 or from the insurance carrier as provided by Section 413.014. The
35-1 rules adopted by the commission shall provide that an insurance
35-2 carrier is eligible for reimbursement for pharmaceutical services
35-3 paid under this section from the subsequent injury fund in the
35-4 event the injury is determined not to be compensable.
35-5 SECTION 4.04. The Texas Workers' Compensation Commission
35-6 shall adopt the rules required under Sections 408.026 and 413.014,
35-7 Labor Code, as amended by this article, not later than February 1,
35-8 2002. The changes in law made by Sections 408.026 and 413.014,
35-9 Labor Code, as amended by this article, apply only to health care
35-10 services requested or provided on or after the effective date of
35-11 the rules adopted by the commission, and the former law is
35-12 continued in effect for health care services requested or provided
35-13 before that date. The commission may adopt rules required by
35-14 Section 413.0141, Labor Code, as added by this article, on or after
35-15 September 1, 2002.
35-16 ARTICLE 5. REQUIRED MEDICAL EXAMINATIONS; DESIGNATED DOCTORS
35-17 SECTION 5.01. Sections 408.004(a) and (c), Labor Code, are
35-18 amended to read as follows:
35-19 (a) The commission may require an employee to submit to
35-20 medical examinations to resolve any question about:
35-21 (1) the appropriateness of the health care received by
35-22 the employee; or
35-23 (2) [the impairment caused by the compensable injury;]
35-24 [(3) the attainment of maximum medical improvement; or]
35-25 [(4)] similar issues.
35-26 (c) The insurance carrier shall pay for:
35-27 (1) an examination required under Subsection (a) or
36-1 (b); and
36-2 (2) the reasonable expenses [expense] incident to the
36-3 employee in submitting to the examination.
36-4 SECTION 5.02. Subchapter A, Chapter 408, Labor Code, is
36-5 amended by adding Section 408.0041 to read as follows:
36-6 Sec. 408.0041. DESIGNATED DOCTOR EXAMINATION. (a) At the
36-7 request of an insurance carrier or an employee, the commission
36-8 shall order a medical examination to resolve any question about:
36-9 (1) the impairment caused by the compensable injury;
36-10 or
36-11 (2) the attainment of maximum medical improvement.
36-12 (b) A medical examination requested under Subsection (a)
36-13 shall be performed by the next available doctor on the commission's
36-14 list of designated doctors whose credentials are appropriate for
36-15 the issue in question and the injured employee's medical condition.
36-16 The designated doctor doing the review must be trained and
36-17 experienced with the treatment and procedures used by the doctor
36-18 treating the patient's medical condition, and the treatment and
36-19 procedures performed must be within the scope of practice of the
36-20 designated doctor. The commission shall assign a designated doctor
36-21 not later than the 10th day after the date on which the request
36-22 under Subsection (a) is received, and the examination must be
36-23 conducted not later than the 21st day after the date on which the
36-24 commission issues the order under Subsection (a). An examination
36-25 under this section may not be conducted more frequently than every
36-26 60 days, unless good cause for more frequent examinations exists,
36-27 as defined by commission rules.
37-1 (c) The treating doctor and the insurance carrier are both
37-2 responsible for sending to the designated doctor all of the injured
37-3 employee's medical records relating to the issue to be evaluated by
37-4 the designated doctor that are in their possession. The treating
37-5 doctor and insurance carrier may send the records without a signed
37-6 release from the employee. The designated doctor is authorized to
37-7 receive the employee's confidential medical records to assist in
37-8 the resolution of disputes. The treating doctor and insurance
37-9 carrier may also send the designated doctor an analysis of the
37-10 injured employee's medical condition, functional abilities, and
37-11 return-to-work opportunities.
37-12 (d) To avoid undue influence on a person selected as a
37-13 designated doctor under this section, and except as provided by
37-14 Subsection (c), only the injured employee or an appropriate member
37-15 of the staff of the commission may communicate with the designated
37-16 doctor about the case regarding the injured employee's medical
37-17 condition or history before the examination of the injured employee
37-18 by the designated doctor. After that examination is completed,
37-19 communication with the designated doctor regarding the injured
37-20 employee's medical condition or history may be made only through
37-21 appropriate commission staff members. The designated doctor may
37-22 initiate communication with any doctor who has previously treated
37-23 or examined the injured employee for the work-related injury or
37-24 with peer reviewers identified by the insurance carrier.
37-25 (e) The designated doctor shall report to the commission.
37-26 The report of the designated doctor has presumptive weight unless
37-27 the great weight of the evidence is to the contrary. An employer
38-1 may make a bona fide offer of employment subject to Sections
38-2 408.103(e) and 408.144(c) based on the designated doctor's report.
38-3 (f) If an insurance carrier is not satisfied with the
38-4 opinion rendered by a designated doctor under this section, the
38-5 insurance carrier may request the commission to order an employee
38-6 to attend an examination by a doctor selected by the insurance
38-7 carrier. The commission shall allow the insurance carrier
38-8 reasonable time to obtain and present the opinion of the doctor
38-9 selected under this subsection before the commission makes a
38-10 decision on the merits of the issue in question.
38-11 (g) The insurance carrier shall pay for:
38-12 (1) an examination required under Subsection (a) or
38-13 (f); and
38-14 (2) the reasonable expenses incident to the employee
38-15 in submitting to the examination.
38-16 (h) An employee is not entitled to compensation, and an
38-17 insurance carrier is authorized to suspend the payment of temporary
38-18 income benefits, during and for a period in which the employee
38-19 fails to submit to an examination required by this chapter unless
38-20 the commission determines that the employee had good cause for the
38-21 failure to submit to the examination. The commission may order
38-22 temporary income benefits to be paid for the period for which the
38-23 commission determined that the employee had good cause. The
38-24 commission by rule shall ensure that:
38-25 (1) an employee receives reasonable notice of an
38-26 examination and the insurance carrier's basis for suspension; and
38-27 (2) the employee is provided a reasonable opportunity
39-1 to reschedule an examination for good cause.
39-2 (i) If the report of a designated doctor indicates that an
39-3 employee has reached maximum medical improvement, the insurance
39-4 carrier may suspend or reduce the payment of temporary income
39-5 benefits immediately.
39-6 (j) The employee or the insurance carrier may request that
39-7 the commission hold an expedited benefit review conference to
39-8 dispute a decision made under this section. The commission shall
39-9 adopt rules as necessary to implement this subsection. This
39-10 subsection expires September 1, 2003.
39-11 SECTION 5.03. Sections 408.122(b) and (c), Labor Code, are
39-12 amended to read as follows:
39-13 (b) To be eligible to serve as a designated doctor, a doctor
39-14 must meet specific qualifications, including training in the
39-15 determination of impairment ratings. The executive director shall
39-16 develop qualification standards and administrative policies to
39-17 implement this subsection, and the commission may adopt rules as
39-18 necessary. The designated doctor doing the review must be trained
39-19 and experienced with the treatment and procedures used by the
39-20 doctor treating the patient's medical condition, and the treatment
39-21 and procedures performed must be within the scope of practice of
39-22 the designated doctor. A designated doctor's credentials must be
39-23 appropriate for the issue in question and the injured employee's
39-24 medical condition. [To the extent possible, a designated doctor
39-25 must be in the same discipline and licensed by the same board of
39-26 examiners as the employee's doctor of choice.]
39-27 (c) [If a dispute exists as to whether the employee has
40-1 reached maximum medical improvement, the commission shall direct
40-2 the employee to be examined by a designated doctor chosen by mutual
40-3 agreement of the parties. If the parties are unable to agree on a
40-4 designated doctor, the commission shall direct the employee to be
40-5 examined by a designated doctor chosen by the commission. The
40-6 designated doctor shall report to the commission.] The report of
40-7 the designated doctor has presumptive weight, and the commission
40-8 shall base its determination of whether the employee has reached
40-9 maximum medical improvement on the report unless the great weight
40-10 of the other medical evidence is to the contrary.
40-11 SECTION 5.04. Section 408.125, Labor Code, is amended to read
40-12 as follows:
40-13 Sec. 408.125. DISPUTE AS TO IMPAIRMENT RATING. (a) If an
40-14 impairment rating is disputed, the commission shall direct the
40-15 employee to the next available doctor on the commission's list of
40-16 designated doctors, as provided by Section 408.0041 [be examined by
40-17 a designated doctor chosen by mutual agreement of the parties].
40-18 (b) [If the parties are unable to agree on a designated
40-19 doctor, the commission shall direct the employee to be examined by
40-20 a designated doctor chosen by the commission.]
40-21 [(c)] The designated doctor shall report in writing to the
40-22 commission.
40-23 (c) The [(d) If the designated doctor is chosen by the
40-24 parties, the commission shall adopt the impairment rating made by
40-25 the designated doctor.]
40-26 [(e) If the designated doctor is chosen by the commission,
40-27 the] report of the designated doctor shall have presumptive weight,
41-1 and the commission shall base the impairment rating on that report
41-2 unless the great weight of the other medical evidence is to the
41-3 contrary. If the great weight of the medical evidence contradicts
41-4 the impairment rating contained in the report of the designated
41-5 doctor chosen by the commission, the commission shall adopt the
41-6 impairment rating of one of the other doctors.
41-7 (d) [(f)] To avoid undue influence on a person selected as a
41-8 designated doctor under this section, only the injured employee or
41-9 an appropriate member of the staff of the commission may
41-10 communicate with the designated doctor about the case regarding the
41-11 injured employee's medical condition or history before the
41-12 examination of the injured employee by the designated doctor. After
41-13 that examination is completed, communication with the designated
41-14 doctor regarding the injured employee's medical condition or
41-15 history may be made only through appropriate commission staff
41-16 members. The designated doctor may initiate communication with any
41-17 doctor who has previously treated or examined the injured employee
41-18 for the work-related injury.
41-19 (e) Notwithstanding Subsection (d), the treating doctor and
41-20 the insurance carrier are both responsible for sending to the
41-21 designated doctor all the injured employee's medical records that
41-22 are in their possession and that relate to the issue to be
41-23 evaluated by the designated doctor. The treating doctor and the
41-24 insurance carrier may send the records without a signed release
41-25 from the employee. The designated doctor is authorized to receive
41-26 the employee's confidential medical records to assist in the
41-27 resolution of disputes. The treating doctor and the insurance
42-1 carrier may also send the designated doctor an analysis of the
42-2 injured employee's medical condition, functional abilities, and
42-3 return-to-work opportunities.
42-4 (f) [(g)] A violation of Subsection (d) [(f)] is a Class C
42-5 administrative violation.
42-6 SECTION 5.05. The Research and Oversight Council on Workers'
42-7 Compensation shall report to the legislature not later than
42-8 December 31, 2004, regarding issues related to medical examinations
42-9 conducted under Section 408.0041, Labor Code, as added by this
42-10 article.
42-11 SECTION 5.06. Section 408.004, Labor Code, as amended by this
42-12 article, and Section 408.0041, Labor Code, as added by this
42-13 article, apply only to a request for a medical examination made to
42-14 the Texas Workers' Compensation Commission by an insurance carrier
42-15 on or after January 1, 2002.
42-16 ARTICLE 6. MEDICAL BENEFIT REGULATION; DISPUTE RESOLUTION
42-17 SECTION 6.01. Section 408.028, Labor Code, is amended to read
42-18 as follows:
42-19 Sec. 408.028. PHARMACEUTICAL SERVICES. (a) A physician
42-20 [health care practitioner] providing care to an employee under this
42-21 subchapter shall prescribe for the employee any necessary
42-22 prescription drugs, and order over-the-counter alternatives to
42-23 prescription medications as clinically appropriate and applicable,
42-24 in accordance with applicable state law and as provided by
42-25 Subsection (b). A doctor providing care may order over-the-counter
42-26 alternatives to prescription medications, when clinically
42-27 appropriate, in accordance with applicable state law and as
43-1 provided by Subsection (b).
43-2 (b) The commission by rule shall develop an open formulary
43-3 under Section 413.011 that requires the use of generic
43-4 pharmaceutical medications and clinically appropriate
43-5 over-the-counter alternatives to prescription medications unless
43-6 otherwise specified by the prescribing doctor, in accordance with
43-7 applicable state law.
43-8 (c) Except as otherwise provided by this subtitle, an [An]
43-9 insurance carrier may not require an employee to use pharmaceutical
43-10 services designated by the carrier.
43-11 (d) The commission shall adopt rules to allow an employee to
43-12 purchase over-the-counter alternatives to prescription medications
43-13 prescribed or ordered under Subsection (a) or (b) and to obtain
43-14 reimbursement from the insurance carrier for those medications.
43-15 SECTION 6.02. Section 413.011, Labor Code, is amended to read
43-16 as follows:
43-17 Sec. 413.011. REIMBURSEMENT POLICIES AND GUIDELINES;
43-18 TREATMENT GUIDELINES [AND MEDICAL POLICIES]. (a) The commission
43-19 [by rule] shall use health care reimbursement policies and
43-20 guidelines that reflect the standardized reimbursement structures
43-21 found in other health care delivery systems with minimal
43-22 modifications to those reimbursement methodologies as necessary to
43-23 meet occupational injury requirements. To achieve standardization,
43-24 the commission shall adopt the most current reimbursement
43-25 methodologies, models, and values or weights used by the federal
43-26 Health Care Financing Administration, including applicable payment
43-27 policies relating to coding, billing, and reporting, and may modify
44-1 documentation requirements as necessary to meet the requirements of
44-2 Section 413.053.
44-3 (b) In determining the appropriate fees, the commission
44-4 shall also develop conversion factors or other payment adjustment
44-5 factors taking into account economic indicators in health care and
44-6 the requirements of Subsection (d). The commission shall also
44-7 provide for reasonable fees for the evaluation and management of
44-8 care as required by Section 408.025(c) and commission rules. This
44-9 section does not adopt the Medicare fee schedule, and the
44-10 commission shall not adopt conversion factors or other payment
44-11 adjustment factors based solely on those factors as developed by
44-12 the federal Health Care Financing Administration.
44-13 (c) This section may not be interpreted in a manner that
44-14 would discriminate in the amount or method of payment or
44-15 reimbursement for services in a manner prohibited by Section 3(d),
44-16 Article 21.52, Insurance Code, or as restricting the ability of
44-17 chiropractors to serve as treating doctors as authorized by this
44-18 subtitle. The commission shall also develop guidelines relating to
44-19 [establish medical policies and guidelines relating to:]
44-20 [(1) fees charged or paid for medical services for
44-21 employees who suffer compensable injuries, including guidelines
44-22 relating to payment of fees for specific medical treatments or
44-23 services;]
44-24 [(2) use of medical services by employees who suffer
44-25 compensable injuries; and]
44-26 [(3)] fees charged or paid for providing expert
44-27 testimony relating to an issue arising under this subtitle.
45-1 (d) [(b)] Guidelines for medical services fees must be fair
45-2 and reasonable and designed to ensure the quality of medical care
45-3 and to achieve effective medical cost control. The guidelines may
45-4 not provide for payment of a fee in excess of the fee charged for
45-5 similar treatment of an injured individual of an equivalent
45-6 standard of living and paid by that individual or by someone acting
45-7 on that individual's behalf. The commission shall consider the
45-8 increased security of payment afforded by this subtitle in
45-9 establishing the fee guidelines.
45-10 (e) The commission by rule may adopt treatment guidelines,
45-11 including return-to-work guidelines. If adopted, treatment
45-12 guidelines adopted must be nationally recognized, scientifically
45-13 valid, and outcome-based and designed to reduce excessive or
45-14 inappropriate medical care while safeguarding necessary medical
45-15 care [(c) Medical policies adopted by the commission must be
45-16 consistent with Sections 413.013, 413.020, 413.052, and 413.053].
45-17 (f) [(d)] The commission by rule may [shall] establish
45-18 medical policies or treatment guidelines relating to necessary
45-19 treatments for injuries.
45-20 (g) Any medical [Medical] policies or guidelines adopted by
45-21 the commission must [shall] be:
45-22 (1) designed to ensure the quality of medical care and
45-23 to achieve effective medical cost control;
45-24 (2) designed to enhance a timely and appropriate
45-25 return to work; and
45-26 (3) consistent with Sections 413.013, 413.020,
45-27 413.052, and 413.053.
46-1 SECTION 6.03. Section 413.015(a), Labor Code, is amended to
46-2 read as follows:
46-3 (a) Insurance carriers shall make appropriate payment of
46-4 charges for medical services provided under this subtitle. An
46-5 insurance carrier may contract with a separate entity to forward
46-6 payments for medical services. Any payment due the insurance
46-7 carrier from the separate entity must be made in accordance with
46-8 the contract. The separate entity is subject to the direction of
46-9 the insurance carrier, and the insurance carrier is responsible for
46-10 the actions of the separate entity under this subsection.
46-11 SECTION 6.04. Section 413.031, Labor Code, is amended to read
46-12 as follows:
46-13 Sec. 413.031. MEDICAL DISPUTE RESOLUTION. (a) A party,
46-14 including a health care provider, is entitled to a review of a
46-15 medical service provided or for which authorization of payment is
46-16 sought if a health care provider is:
46-17 (1) denied payment or paid a reduced amount for the
46-18 medical service rendered;
46-19 (2) denied authorization for the payment for the
46-20 service requested or performed if authorization is required or
46-21 allowed by this subtitle or [the medical policies of the]
46-22 commission rules; [or]
46-23 (3) ordered by the commission [division] to refund a
46-24 payment received; or
46-25 (4) ordered to make a payment that was refused or
46-26 reduced for a medical service rendered.
46-27 (b) A health care provider who submits a charge in excess of
47-1 the fee guidelines or treatment policies is entitled to a review of
47-2 the medical service to determine if reasonable medical
47-3 justification exists for the deviation. A claimant is entitled to
47-4 a review of a medical service for which preauthorization is sought
47-5 by the health care provider and denied by the insurance carrier.
47-6 The commission shall adopt rules to notify claimants of their
47-7 rights under this subsection.
47-8 (c) In resolving disputes over the amount of payment due for
47-9 services determined to be medically necessary and appropriate for
47-10 treatment of a compensable injury, the role of the commission is to
47-11 adjudicate the payment given the relevant statutory provisions and
47-12 commission rules. The commission shall publish on its Internet
47-13 website its medical dispute decisions, including decisions of
47-14 independent review organizations, and any subsequent decisions by
47-15 the State Office of Administrative Hearings. Before publication,
47-16 the commission shall redact only that information necessary to
47-17 prevent identification of the injured worker.
47-18 (d) A review of the medical necessity of a health care
47-19 [medical] service requiring preauthorization under Section 413.014
47-20 or commission rules under that [this] section shall be conducted by
47-21 an independent review organization under Article 21.58C, Insurance
47-22 Code, in the same manner as reviews of utilization review decisions
47-23 by health maintenance organizations. It is a defense for the
47-24 insurance carrier if the carrier timely complies with the decision
47-25 of the independent review organization [provided by a health care
47-26 provider professional review organization if requested by the
47-27 health care practitioner or if ordered by the commission].
48-1 (e) Except as provided by Subsection (d), a review of the
48-2 medical necessity of a health care service provided under this
48-3 chapter or Chapter 408 shall be conducted by an independent review
48-4 organization under Article 21.58C, Insurance Code, in the same
48-5 manner as reviews of utilization review decisions by health
48-6 maintenance organizations. It is a defense for the insurance
48-7 carrier if the carrier timely complies with the decision of the
48-8 independent review organization.
48-9 (f) The commission by rule shall specify the appropriate
48-10 dispute resolution process for disputes in which a claimant has
48-11 paid for medical services and seeks reimbursement.
48-12 (g) In performing a review of medical necessity under
48-13 Subsection (d) or (e), an independent review organization may
48-14 request that the commission order an examination by a designated
48-15 doctor under Chapter 408.
48-16 (h) The insurance carrier shall pay the cost of the review
48-17 if the dispute arises in connection with a request for health care
48-18 services that require preauthorization under Section 413.014 or
48-19 commission rules under that section.
48-20 (i) Except as provided by Subsection (h), the cost of the
48-21 review shall be paid by the nonprevailing party.
48-22 (j) Notwithstanding Subsections (h) and (i), an employee may
48-23 not be required to pay any portion of the cost of a review.
48-24 (k) Except as provided by Subsection (l), a [(d) A] party
48-25 to a medical dispute that remains unresolved after a review of the
48-26 medical service under this section is entitled to a hearing. The
48-27 hearing shall be conducted by the State Office of Administrative
49-1 Hearings within 90 days of receipt of a request for a hearing in
49-2 the manner provided for a contested case under Chapter 2001,
49-3 Government Code (the administrative procedure law). A party who has
49-4 exhausted the party's administrative remedies under this subtitle
49-5 and who is aggrieved by a final decision of the State Office of
49-6 Administrative Hearings may seek judicial review of the decision.
49-7 Judicial review under this subsection shall be conducted in the
49-8 manner provided for judicial review of contested cases under
49-9 Subchapter G, Chapter 2001, Government Code.
49-10 (l) A party to a medical dispute regarding spinal surgery
49-11 that remains unresolved after a review by an independent review
49-12 organization as provided by Subsections (d) and (e) is entitled to
49-13 dispute resolution as provided by Chapter 410.
49-14 SECTION 6.05. Section 413.041, Labor Code, is amended to read
49-15 as follows:
49-16 Sec. 413.041. DISCLOSURE. (a) Each health care practitioner
49-17 shall disclose to the commission the identity of any health care
49-18 provider in which the health care practitioner, or the health care
49-19 provider that employs the health care practitioner, has a financial
49-20 interest. The health care practitioner shall make the disclosure
49-21 in the manner provided by commission rule.
49-22 (b) The commission shall require by rule that a doctor
49-23 disclose financial interests in other health care providers as a
49-24 condition of registration for the approved doctor list established
49-25 under Section 408.023 and shall define "financial interest" for
49-26 purposes of this subsection as provided by analogous federal
49-27 regulations. The commission by rule shall adopt the federal
50-1 standards that prohibit the payment or acceptance of payment in
50-2 exchange for health care referrals relating to fraud, abuse, and
50-3 antikickbacks.
50-4 (c) A health care provider that fails to comply with this
50-5 section is subject to penalties and sanctions as provided by this
50-6 subtitle, including forfeiture of the right to reimbursement for
50-7 services rendered during the period of noncompliance.
50-8 (d) The commission shall publish all final disclosure
50-9 enforcement orders issued under this section on the commission's
50-10 Internet website. [A health care provider who refers a workers'
50-11 compensation claimant to another health care provider in which the
50-12 referring provider has more than a five percent financial interest
50-13 shall file an annual disclosure statement with the commission as
50-14 provided by commission rules and shall disclose the interest to the
50-15 insurance carrier at the time of the referral. The referring
50-16 provider shall specify the degree of the financial interest and
50-17 shall provide other information as required by commission rules.]
50-18 SECTION 6.06. Section 415.0035, Labor Code, is amended by
50-19 adding Subsections (e) and (f) to read as follows:
50-20 (e) An insurance carrier or health care provider commits an
50-21 administrative violation if that person violates this subtitle or a
50-22 rule, order, or decision of the commission.
50-23 (f) A subsequent administrative violation under this
50-24 section, after prior notice to the insurance carrier or health care
50-25 provider of noncompliance, is subject to penalties as provided by
50-26 Section 415.021. Prior notice under this subsection is not required
50-27 if the violation was committed wilfully or intentionally, or if the
51-1 violation was of a decision or order of the commission.
51-2 SECTION 6.07. Section 415.021(a), Labor Code, is amended to
51-3 read as follows:
51-4 (a) The commission may assess an administrative penalty
51-5 against a person who commits an administrative violation.
51-6 Notwithstanding Subsection (c), the commission by rule shall adopt
51-7 a schedule of specific monetary administrative penalties for
51-8 specific violations under this subtitle.
51-9 SECTION 6.08. Section 415.023, Labor Code, is amended to read
51-10 as follows:
51-11 Sec. 415.023. COMMISSION OF WRONGFUL ACT AS MATTER OF
51-12 PRACTICE; ADMINISTRATIVE VIOLATION. (a) A person who commits an
51-13 administrative violation under Section 415.001, 415.002, [or]
51-14 415.003, or 415.0035 as a matter of practice is subject to an
51-15 applicable rule adopted under Subsection (b) in addition to the
51-16 penalty assessed for the violation.
51-17 (b) The commission may adopt rules providing for:
51-18 (1) a reduction or denial of fees;
51-19 (2) public or private reprimand by the commission;
51-20 (3) suspension from practice before the commission;
51-21 [or]
51-22 (4) restriction, suspension, or revocation of the
51-23 right to receive reimbursement under this subtitle; or
51-24 (5) referral and petition to the appropriate licensing
51-25 authority for appropriate disciplinary action, including the
51-26 restriction, suspension, or revocation of the person's license.
51-27 SECTION 6.09. (a) The Texas Workers' Compensation Commission
52-1 shall adopt the rules required by Section 408.028, Labor Code, as
52-2 amended by this article, not later than February 1, 2002.
52-3 (b) The Texas Workers' Compensation Commission shall adopt
52-4 the rules and fee guidelines under Section 413.011, Labor Code, as
52-5 amended by this article, not later than May 1, 2002. The treatment
52-6 guidelines adopted under Chapter 413, Labor Code, in effect
52-7 immediately before September 1, 2001, are abolished on January 1,
52-8 2002.
52-9 (c) The Texas Workers' Compensation Commission shall adopt
52-10 rules as required by Section 413.041, Labor Code, as amended by
52-11 this article, not later than June 1, 2002.
52-12 (d) The change in law made by this article by the amendment
52-13 of Section 413.031, Labor Code, applies only to a request for a
52-14 review of medical services filed with the Texas Workers'
52-15 Compensation Commission on or after January 1, 2002. A request
52-16 filed with the commission before that date is covered by the law in
52-17 effect immediately before January 1, 2002, and that law is
52-18 continued in effect for that purpose.
52-19 (e) Section 413.041(c), Labor Code, as added by this
52-20 article, applies only to a failure to comply with Section 413.041
52-21 that occurs after June 1, 2002.
52-22 (f) Sections 415.023 and 415.0035, Labor Code, as amended by
52-23 this article, apply only to a violation occurring on or after
52-24 September 1, 2001.
52-25 ARTICLE 7. SUNSET REVIEW; AUDIT
52-26 SECTION 7.01. Section 401.002, Labor Code, is amended to read
52-27 as follows:
53-1 Sec. 401.002. APPLICATION OF SUNSET ACT. The Texas Workers'
53-2 Compensation Commission is subject to Chapter 325, Government Code
53-3 (Texas Sunset Act). Unless continued in existence as provided by
53-4 that chapter, the commission is abolished September 1, 2005 [2007].
53-5 SECTION 7.02. Subchapter A, Chapter 401, Labor Code, is
53-6 amended by adding Section 401.003 to read as follows:
53-7 Sec. 401.003. ACTIVITIES OF THE STATE AUDITOR. (a) The
53-8 commission is subject to audit by the state auditor in accordance
53-9 with Chapter 321, Government Code. The state auditor may audit the
53-10 commission's:
53-11 (1) structure and internal controls;
53-12 (2) level and quality of service provided to
53-13 employers, injured employees, insurance carriers, self-insured
53-14 governmental entities, and other participants;
53-15 (3) implementation of statutory mandates;
53-16 (4) employee turnover;
53-17 (5) information management systems, including public
53-18 access to nonconfidential information;
53-19 (6) adoption and implementation of administrative
53-20 rules; and
53-21 (7) assessment of administrative violations and the
53-22 penalties for those violations.
53-23 (b) Nothing in this section limits the authority of the
53-24 state auditor under Chapter 321, Government Code.
53-25 ARTICLE 8. ATTORNEY'S FEES
53-26 SECTION 8.01. Section 408.221, Labor Code, is amended to read
53-27 as follows:
54-1 Sec. 408.221. ATTORNEY'S FEES PAID TO CLAIMANT'S COUNSEL.
54-2 (a) An attorney's fee, including a contingency fee, for
54-3 representing a claimant before the commission or court under this
54-4 subtitle must be approved by the commission or court.
54-5 (b) Except as otherwise provided, an attorney's fee under
54-6 this section is based on the attorney's time and expenses according
54-7 to written evidence presented to the commission or court. Except as
54-8 provided by Subsection (c) or Section 408.147(c), the attorney's
54-9 fee shall be paid from the claimant's recovery.
54-10 (c) An insurance carrier that seeks judicial review under
54-11 Subchapter G, Chapter 410, of a final decision of a commission
54-12 appeals panel regarding compensability or eligibility for, or the
54-13 amount of, income or death benefits is liable for reasonable and
54-14 necessary attorney's fees as provided by Subsection (d) incurred by
54-15 the claimant as a result of the insurance carrier's appeal if the
54-16 claimant prevails on an issue on which judicial review is sought by
54-17 the insurance carrier in accordance with the limitation of issues
54-18 contained in Section 410.302. If the carrier appeals multiple
54-19 issues and the claimant prevails on some, but not all, of the
54-20 issues appealed, the court shall apportion and award fees to the
54-21 claimant's attorney only for the issues on which the claimant
54-22 prevails. In making that apportionment, the court shall consider
54-23 the factors prescribed by Subsection (d). This subsection does not
54-24 apply to attorney's fees for which an insurance carrier may be
54-25 liable under Section 408.147. An award of attorney's fees under
54-26 this subsection is not subject to commission rules adopted under
54-27 Subsection (f). This subsection expires September 1, 2005.
55-1 (d) In approving an attorney's fee under this section, the
55-2 commission or court shall consider:
55-3 (1) the time and labor required;
55-4 (2) the novelty and difficulty of the questions
55-5 involved;
55-6 (3) the skill required to perform the legal services
55-7 properly;
55-8 (4) the fee customarily charged in the locality for
55-9 similar legal services;
55-10 (5) the amount involved in the controversy;
55-11 (6) the benefits to the claimant that the attorney is
55-12 responsible for securing; and
55-13 (7) the experience and ability of the attorney
55-14 performing the services.
55-15 (e) [(d)] The commission by rule or the court may provide
55-16 for the commutation of an attorney's fee, except that the
55-17 attorney's fee shall be paid in periodic payments in a claim
55-18 involving death benefits if the only dispute is as to the proper
55-19 beneficiary or beneficiaries.
55-20 (f) [(e)] The commission by rule shall provide guidelines
55-21 for maximum attorney's fees for specific services in accordance
55-22 with this section.
55-23 (g) [(f)] An attorney's fee may not be allowed in a case
55-24 involving a fatal injury or lifetime income benefit if the
55-25 insurance carrier admits liability on all issues and tenders
55-26 payment of maximum benefits in writing under this subtitle while
55-27 the claim is pending before the commission.
56-1 (h) [(g)] An attorney's fee shall be paid to the attorney by
56-2 separate draft.
56-3 (i) [(h)] Except as provided by Subsection (c) or Section
56-4 408.147(c), an attorney's fee may not exceed 25 percent of the
56-5 claimant's recovery.
56-6 SECTION 8.02. Section 408.147(c), Labor Code, is amended to
56-7 read as follows:
56-8 (c) If an insurance carrier disputes a commission
56-9 determination that an employee is entitled to supplemental income
56-10 benefits or the amount of supplemental income benefits due and the
56-11 employee prevails on any disputed issue, the insurance carrier is
56-12 liable for reasonable and necessary attorney's fees incurred by the
56-13 employee as a result of the insurance carrier's dispute and for
56-14 supplemental income benefits accrued but not paid and interest on
56-15 that amount, according to Section 408.064. Attorney's fees awarded
56-16 under this subsection are not subject to Sections 408.221(b), (f)
56-17 [(e)], and (i) [(h)].
56-18 SECTION 8.03. Section 408.222(b), Labor Code, is amended to
56-19 read as follows:
56-20 (b) In determining whether a fee is reasonable under this
56-21 section, the commission or court shall consider issues analogous to
56-22 those listed under Section 408.221(d) [408.221(c)]. The defense
56-23 counsel shall present written evidence to the commission or court
56-24 relating to:
56-25 (1) the time spent and expenses incurred in defending
56-26 the case; and
56-27 (2) other evidence considered necessary by the
57-1 commission or court in making a determination under this section.
57-2 SECTION 8.04. The change in law made by this article applies
57-3 only to a request for judicial review that occurs on or after
57-4 September 1, 2001. A request for judicial review that occurs
57-5 before that date is governed by the law in effect on the date the
57-6 request is made, and the former law is continued in effect for that
57-7 purpose.
57-8 ARTICLE 9. LIFETIME INCOME BENEFITS
57-9 SECTION 9.01. Section 408.161(a), Labor Code, is amended to
57-10 read as follows:
57-11 (a) Lifetime income benefits are paid until the death of the
57-12 employee for:
57-13 (1) total and permanent loss of sight in both eyes;
57-14 (2) loss of both feet at or above the ankle;
57-15 (3) loss of both hands at or above the wrist;
57-16 (4) loss of one foot at or above the ankle and the
57-17 loss of one hand at or above the wrist;
57-18 (5) an injury to the spine that results in permanent
57-19 and complete paralysis of both arms, both legs, or one arm and one
57-20 leg; [or]
57-21 (6) a physically traumatic injury to the brain
57-22 resulting in incurable insanity or imbecility; or
57-23 (7) third degree burns that cover at least 40 percent
57-24 of the body and require grafting, or third degree burns covering
57-25 the majority of either both hands or one hand and the face.
58-1 ARTICLE 10. AVERAGE WEEKLY WAGE; MULTIPLE EMPLOYMENT; SUBSEQUENT
58-2 INJURY FUND
58-3 SECTION 10.01. Section 403.006, Labor Code, is amended by
58-4 amending Subsection (b) and adding Subsection (d) to read as
58-5 follows:
58-6 (b) The subsequent injury fund is liable for:
58-7 (1) the payment of compensation as provided by Section
58-8 408.162;
58-9 (2) reimbursement of insurance carrier claims of
58-10 overpayment of benefits made under an interlocutory order or
58-11 decision of the commission as provided by this subtitle, consistent
58-12 with the priorities established by rule by the commission;
58-13 (3) reimbursement of insurance carrier claims as
58-14 provided by Sections 408.042 and 413.0141, consistent with the
58-15 priorities established by rule by the commission; and
58-16 (4) the payment of an assessment of feasibility and
58-17 the development of regional networks established under Section
58-18 408.0221.
58-19 (d) Based on an actuarial assessment of the funding
58-20 available under Section 403.007(e), the commission may make partial
58-21 payment of insurance carrier claims under Subsection (b)(3).
58-22 SECTION 10.02. Section 403.007, Labor Code, is amended by
58-23 adding Subsections (e) and (f) to read as follows:
58-24 (e) If the commission determines that the funding under
58-25 Subsection (a) is not adequate to meet the expected obligations of
58-26 the subsequent injury fund established under Section 403.006, the
58-27 fund shall be supplemented by the collection of a maintenance tax
59-1 paid by insurance carriers, other than a governmental entity, as
59-2 provided by Sections 403.002 and 403.003. The rate of assessment
59-3 must be adequate to provide 120 percent of the projected unfunded
59-4 liabilities of the fund for the next biennium as certified by an
59-5 independent actuary or financial advisor.
59-6 (f) The commission's actuary or financial advisor shall
59-7 report biannually to the Research and Oversight Council on Workers'
59-8 Compensation on the financial condition and projected assets and
59-9 liabilities of the subsequent injury fund. The commission shall
59-10 make the reports available to members of the legislature and the
59-11 public. The commission may purchase annuities to provide for
59-12 payments due to claimants under this subtitle if the commission
59-13 determines that the purchase of annuities is financially prudent
59-14 for the administration of the fund.
59-15 SECTION 10.03. Section 408.042, Labor Code, is amended to
59-16 read as follows:
59-17 Sec. 408.042. AVERAGE WEEKLY WAGE FOR PART-TIME EMPLOYEE OR
59-18 EMPLOYEE WITH MULTIPLE EMPLOYMENT. (a) The average weekly wage of
59-19 a part-time employee who limits the employee's work to less than
59-20 [full-time hours or] a full-time workweek as a regular course of
59-21 that employee's conduct is computed as provided by Section 408.041.
59-22 (b) For part-time employees not covered by Subsection (a),
59-23 the average weekly wage:
59-24 (1) for determining temporary income benefits is
59-25 computed as provided by Section 408.041; and
59-26 (2) for determining impairment income benefits,
59-27 supplemental income benefits, lifetime income benefits, and death
60-1 benefits is computed as follows:
60-2 (A) if the employee has worked for the employer
60-3 for at least the 13 weeks immediately preceding the date of the
60-4 injury, the average weekly wage is computed by dividing the sum of
60-5 the wages paid in the 13 consecutive weeks immediately preceding
60-6 the date of the injury by 13 and adjusting that amount to the
60-7 weekly wage level the employee would have attained by working a
60-8 full-time workweek at the same rate of pay; or
60-9 (B) if the employee has worked for the employer
60-10 for less than 13 weeks immediately preceding the date of the
60-11 injury, the average weekly wage is equal to:
60-12 (i) the weekly wage that the employer pays
60-13 a similar employee for similar services based on a [in] full-time
60-14 workweek [employment]; or
60-15 (ii) if a similar employee does not exist,
60-16 the usual wage paid in that vicinity for the same or similar
60-17 services based on a [provided for compensation in] full-time
60-18 workweek [employment].
60-19 (c) For employees with multiple employment, the average
60-20 weekly wage for determining temporary income benefits, impairment
60-21 income benefits, supplemental income benefits, lifetime income
60-22 benefits, and death benefits, is computed as follows:
60-23 (1) the average weekly wage for an employee with
60-24 multiple employment is equal to the sum of the average weekly wages
60-25 computed under Subdivisions (2) and (3);
60-26 (2) for each of the employers for whom the employee
60-27 has worked for at least the 13 weeks immediately preceding the date
61-1 of injury, the average weekly wage is equal to the sum of the wages
61-2 paid by that employer to the employee in the 13 weeks immediately
61-3 preceding the injury divided by 13;
61-4 (3) for each of the employers for whom the employee
61-5 has worked for less than the 13 weeks immediately preceding the
61-6 date of the injury, the average weekly wage is equal to:
61-7 (A) the weekly wage that employer pays similar
61-8 employees for similar services; or
61-9 (B) if a similar employee does not exist, the
61-10 usual weekly wage paid in that vicinity for the same or similar
61-11 services; and
61-12 (4) the average weekly wage of an employee with
61-13 multiple employment who limits the employee's work to less than a
61-14 full-time workweek, but does not do so as a regular course of that
61-15 employee's conduct, is adjusted to the weekly wage level the
61-16 employee would have attained by working a full-time workweek at the
61-17 employee's average rate of pay.
61-18 (d) The commission shall:
61-19 (1) prescribe a form to collect information regarding
61-20 the wages of employees with multiple employment; and
61-21 (2) by rule, determine the manner by which the
61-22 commission collects and distributes wage information to implement
61-23 this section.
61-24 (e) For an employee with multiple employment, only the
61-25 employee's wages that are reportable for federal income tax
61-26 purposes may be considered. The employee shall document and verify
61-27 wage payments subject to this section.
62-1 (f) If the commission determines that computing the average
62-2 weekly wage for an employee as provided by Subsection (c) is
62-3 impractical or unreasonable, the commission shall set the average
62-4 weekly wage in a manner that more fairly reflects the employee's
62-5 average weekly wage and that is fair and just to both parties or is
62-6 in the manner agreed to by the parties. The commission by rule may
62-7 define methods to determine a fair and just average weekly wage
62-8 consistent with this section.
62-9 (g) An insurance carrier is entitled to apply for and
62-10 receive reimbursement at least annually from the subsequent injury
62-11 fund for the amount of income benefits paid to a worker under this
62-12 section that are based on employment other than the employment
62-13 during which the compensable injury occurred. The commission may
62-14 adopt rules that govern the documentation, application process, and
62-15 other administrative requirements necessary to implement this
62-16 subsection.
62-17 (h) In this section:
62-18 (1) "Employee with multiple employment" means an
62-19 employee who has more than one employer.
62-20 (2) "Full-time workweek" means a 40-hour workweek.
62-21 (3) "Part-time[, "part-time] employee" means an
62-22 employee who, at the time of the injury, was working less than a
62-23 [the] full-time [hours or full-time] workweek for the employer for
62-24 whom the employee was working when the compensable injury occurred
62-25 [of similar employees in the same employment, whether for the same
62-26 or a different employer].
62-27 SECTION 10.04. Subchapter C, Chapter 408, Labor Code, is
63-1 amended by adding Section 408.0446 to read as follows:
63-2 Sec. 408.0446. AVERAGE WEEKLY WAGE; SCHOOL DISTRICT
63-3 EMPLOYEE. (a) For determining the amount of temporary income
63-4 benefits of a school district employee under Chapter 504, the
63-5 average weekly wage is computed on the basis of wages earned in a
63-6 week rather than on the basis of wages paid in a week. The wages
63-7 earned in any given week are equal to the amount that would be
63-8 deducted from an employee's salary if the employee were absent from
63-9 work for one week and the employee did not have personal leave
63-10 available to compensate the employee for lost wages for that week.
63-11 (b) An insurance carrier may adjust a school district
63-12 employee's average weekly wage as often as necessary to reflect the
63-13 wages the employee reasonably could expect to earn during the
63-14 period for which temporary income benefits are paid. In adjusting
63-15 a school district employee's average weekly wage under this
63-16 subsection, the insurance carrier may consider any evidence of the
63-17 employee's reasonable expectation of earnings.
63-18 (c) For determining the amount of impairment income
63-19 benefits, supplemental income benefits, lifetime income benefits,
63-20 or death benefits of a school district employee under Chapter 504,
63-21 the average weekly wage of the employee is computed by dividing the
63-22 total amount of wages earned by the employee during the 12 months
63-23 immediately preceding the date of the injury by 50.
63-24 (d) If the commission determines that computing the average
63-25 weekly wage of a school district employee as provided by this
63-26 section is impractical because the employee did not earn wages
63-27 during the 12 months immediately preceding the date of the injury,
64-1 the commission shall compute the average weekly wage in a manner
64-2 that is fair and just to both parties.
64-3 (e) The commission shall adopt rules as necessary to
64-4 implement this section.
64-5 SECTION 10.05. (a) Except as provided by Subsection (b) of
64-6 this section, the change in law made by this article applies only
64-7 to a claim for workers' compensation benefits based on a
64-8 compensable injury that occurs on or after July 1, 2002. A claim
64-9 based on a compensable injury that occurs before that date is
64-10 governed by the law in effect on the date the compensable injury
64-11 occurred, and the former law is continued in effect for that
64-12 purpose.
64-13 (b) Section 408.0446, Labor Code, as added by this article,
64-14 takes effect December 1, 2001, and applies only to a claim for
64-15 workers' compensation benefits based on a compensable injury that
64-16 occurs on or after that date. A claim based on a compensable
64-17 injury that occurs before that date is governed by the law in
64-18 effect on the date that the compensable injury occurred, and the
64-19 former law is continued in effect for that purpose.
64-20 ARTICLE 11. INSURANCE CARRIER INFORMATION
64-21 SECTION 11.01. Section 410.164, Labor Code, is amended by
64-22 adding Subsection (c) to read as follows:
64-23 (c) At each contested case hearing, as applicable, the
64-24 insurance carrier shall file with the hearing officer and shall
64-25 deliver to the claimant a single document stating the true
64-26 corporate name of the insurance carrier and the name and address of
64-27 the insurance carrier's registered agent for service of process.
65-1 The document is part of the record of the contested case hearing.
65-2 SECTION 11.02. Section 410.204, Labor Code, is amended by
65-3 adding Subsection (d) to read as follows:
65-4 (d) Each final decision of the appeals panel shall conclude
65-5 with a separate paragraph stating: "The true corporate name of the
65-6 insurance carrier is (NAME IN BOLD PRINT) and the name and address
65-7 of its registered agent for service of process is (NAME AND ADDRESS
65-8 IN BOLD PRINT)."
65-9 SECTION 11.03. The change in law made by this article applies
65-10 only to a workers' compensation hearing that is conducted on or
65-11 after the effective date of this Act. A hearing that is conducted
65-12 before that date is governed by the law in effect on the date the
65-13 hearing was conducted, and the former law is continued in effect
65-14 for that purpose.
65-15 ARTICLE 12. APPEAL REQUIREMENTS
65-16 SECTION 12.01. Section 410.202, Labor Code, is amended by
65-17 adding Subsection (d) to read as follows:
65-18 (d) Saturdays and Sundays and holidays listed in Section
65-19 662.003, Government Code, are not included in the computation of
65-20 the time in which a request for an appeal under Subsection (a) or
65-21 a response under Subsection (b) must be filed.
65-22 SECTION 12.02. The change in law made by this article applies
65-23 only to an appeal in a workers' compensation proceeding filed on or
65-24 after the effective date of this Act. An appeal filed before the
65-25 effective date of this Act is governed by the law in effect on the
65-26 date the appeal was filed, and the former law is continued in
65-27 effect for that purpose.
66-1 ARTICLE 13. STUDY ON DRUG-FREE WORKPLACE REQUIREMENTS
66-2 SECTION 13.01. Subchapter G, Chapter 411, Labor Code, is
66-3 amended by adding Section 411.093 to read as follows:
66-4 Sec. 411.093. STUDY ON DRUG-FREE WORKPLACE; REPORT. (a) The
66-5 commission shall study:
66-6 (1) the implementation and development of drug-free
66-7 workplace policies under this subchapter;
66-8 (2) the use of drug-free workplace requirements
66-9 adopted by other jurisdictions to reduce the adverse impact on the
66-10 operation of workers' compensation insurance systems of drug abuse
66-11 and its effects in the workplace; and
66-12 (3) any other aspects of the effect of drug abuse on
66-13 the operation of the workers' compensation insurance system in this
66-14 state as considered appropriate by the commission or the Research
66-15 and Oversight Council on Workers' Compensation.
66-16 (b) The commission shall report not later than February 1,
66-17 2003, to the legislature and the Research and Oversight Council on
66-18 Workers' Compensation regarding the study conducted under this
66-19 section. The report must include:
66-20 (1) any commission recommendations for legislative
66-21 changes in the workers' compensation laws regarding the
66-22 implementation of a drug-free workplace requirement; and
66-23 (2) an analysis of the possible effects of the
66-24 adoption of a workers' compensation insurance premium discount
66-25 program for employers who maintain a drug-free workplace on the
66-26 operation of the workers' compensation insurance system in this
66-27 state.
67-1 (c) On the request of the commission, the Texas Department
67-2 of Insurance shall assist the commission in the performance of its
67-3 duties under this section.
67-4 (d) This section expires September 1, 2003.
67-5 ARTICLE 14. WORKERS' COMPENSATION
67-6 FOR STATE EMPLOYEES
67-7 SECTION 14.01. Subchapter B, Chapter 412, Labor Code, is
67-8 amended by amending Section 412.012 and adding Sections
67-9 412.0121-412.0124 to read as follows:
67-10 Sec. 412.012. FUNDING. [(a)] The office shall be
67-11 administered through money appropriated by the legislature and
67-12 through [(1) interagency contracts for the risk management program
67-13 and (2)] the allocation program for the financing of state
67-14 workers' compensation benefits and risk management costs.
67-15 Sec. 412.0121. INTERAGENCY CONTRACTS. (a) [(b) Interagency
67-16 Contracts. (1)] Each state agency shall enter into an interagency
67-17 contract with the office under Chapter 771, Government Code, to pay
67-18 the costs incurred by the office in administering this chapter for
67-19 the benefit of that state agency.
67-20 (b) Costs payable under the contract include the cost of:
67-21 (1) [(A)] services of office employees;
67-22 (2) [(B)] materials; and
67-23 (3) [(C)] equipment, including computer hardware and
67-24 software.
67-25 (c) [(2)] The [amount of the] costs of risk management
67-26 services provided [to be paid] by a state agency under the
67-27 interagency contract shall be allocated in the same proportion and
68-1 determined in the same manner as the costs of workers' compensation
68-2 [is based on:]
68-3 [(A) the number of employees of the agency
68-4 compared with the total number of employees of all state agencies
68-5 to which this chapter applies;]
68-6 [(B) the dollar value of the agency's property
68-7 and asset and liability exposure compared to that of all state
68-8 agencies to which this chapter applies; and]
68-9 [(C) the number and aggregate cost of claims and
68-10 losses incurred by the state agency compared to those incurred by
68-11 all state agencies to which this chapter applies].
68-12 Sec. 412.0122. STATE SELF-INSURING FOR WORKERS'
68-13 COMPENSATION. [(c)] The state is self-insuring with respect to an
68-14 employee's compensable injury. [The legislature shall appropriate
68-15 the amount designated by the appropriation structure for the
68-16 payment of state workers' compensation claims costs to the office.
68-17 This section does not affect the reimbursement of claims costs by
68-18 funds other than general revenue funds, as provided by the General
68-19 Appropriations Act.]
68-20 Sec. 412.0123. ALLOCATION OF WORKERS' COMPENSATION AND RISK
68-21 MANAGEMENT COSTS; RISK REWARD PROGRAM. (a) The office shall
68-22 establish a risk reward for the payment of workers' compensation
68-23 claims and risk management services that are incurred by a state
68-24 agency subject to Chapter 501.
68-25 (b) The office shall establish a formula for allocating the
68-26 state's workers' compensation costs among covered agencies based on
68-27 the claims experience of each agency, the current and projected
69-1 size of each agency's workforce, each agency's payroll, the related
69-2 costs incurred in administering claims, and other factors that the
69-3 office determines to be relevant. The agency may provide modifiers
69-4 to the formula to promote the effective implementation of risk
69-5 management programs by state agencies.
69-6 (c) The board has final authority to determine the
69-7 assessments to be paid by the covered agencies.
69-8 Sec. 412.0124. DEPOSIT OF WORKERS' COMPENSATION SUBROGATION
69-9 RECOVERIES. [(d) State Workers' Compensation Account. (1)] All
69-10 money recovered by the director from a third party through
69-11 subrogation shall be deposited into the state workers' compensation
69-12 account in general revenue.
69-13 [(2) Funds deposited under this section may be used
69-14 for the payment of compensation and other benefits to state
69-15 employees.]
69-16 SECTION 14.02. Section 501.001(5), Labor Code, is amended to
69-17 read as follows:
69-18 (5) "Employee" means a person who is:
69-19 (A) in the service of the state pursuant to an
69-20 election, appointment, or express oral or written contract of hire;
69-21 (B) paid from state funds but whose duties
69-22 require that the person work and frequently receive supervision in
69-23 a political subdivision of the state;
69-24 (C) a peace officer employed by a political
69-25 subdivision, while the peace officer is exercising authority
69-26 granted under:
69-27 (i) Article 12, Code of Criminal
70-1 Procedure; or
70-2 (ii) Articles 14.03(d) and (g) [Article
70-3 14.03(c)], Code of Criminal Procedure; or
70-4 (D) a member of the state military forces, as
70-5 defined by Section 431.001, Government Code, who is engaged in
70-6 authorized training or duty.
70-7 SECTION 14.03. Subchapter C, Chapter 505, Labor Code, is
70-8 amended by adding Section 505.060 to read as follows:
70-9 Sec. 505.060. EFFECT OF SICK LEAVE; ANNUAL LEAVE. (a) An
70-10 employee may elect to use accrued sick leave before receiving
70-11 income benefits. If an employee elects to use sick leave, the
70-12 employee is not entitled to income benefits under this chapter
70-13 until the employee has exhausted the employee's accrued sick leave.
70-14 (b) An employee may elect to use all or any number of weeks
70-15 of accrued annual leave after the employee's accrued sick leave is
70-16 exhausted. If an employee elects to use annual leave, the employee
70-17 is not entitled to income benefits under this chapter until the
70-18 elected number of weeks of leave have been exhausted.
70-19 ARTICLE 15. INTEREST OR DISCOUNT RATE
70-20 SECTION 15.01. Section 401.023(b), Labor Code, is amended to
70-21 read as follows:
70-22 (b) The commission shall compute and publish the interest
70-23 and discount rate quarterly, using the treasury constant maturity
70-24 [auction] rate [quoted on a discount basis] for one-year [the
70-25 52-week] treasury bills issued by the United States government, as
70-26 published by the Federal Reserve Board on [the date nearest to] the
70-27 15th day preceding the first day of the calendar quarter for which
71-1 the rate is to be effective, plus 3.5 percent. For this purpose,
71-2 calendar quarters begin January 1, April 1, July 1, and October 1.
71-3 ARTICLE 16. PROHIBITION ON CERTAIN WAIVERS
71-4 SECTION 16.01. Section 406.033, Labor Code, is amended by
71-5 adding Subsection (e) to read as follows:
71-6 (e) A cause of action described in Subsection (a) may not be
71-7 waived by an employee before the employee's injury or death. Any
71-8 agreement by an employee to waive a cause of action or any right
71-9 described in Subsection (a) before the employee's injury or death
71-10 is void and unenforceable.
71-11 ARTICLE 17. GENERAL TRANSITION; EFFECTIVE DATE
71-12 SECTION 17.01. Except as otherwise provided by this Act, this
71-13 Act applies only to a claim for workers' compensation benefits
71-14 based on a compensable injury that occurs on or after the effective
71-15 date of this Act. A claim based on a compensable injury that
71-16 occurs before that date is governed by the law in effect on the
71-17 date the compensable injury occurred, and the former law is
71-18 continued in effect for that purpose.
71-19 SECTION 17.02. Except as expressly provided, this Act takes
71-20 effect immediately if it receives a vote of two-thirds of all the
71-21 members elected to each house, as provided by Section 39, Article
71-22 III, Texas Constitution. Except as otherwise provided by this Act,
71-23 if this Act does not receive the vote necessary for immediate
71-24 effect, this Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2600 was passed by the House on April
25, 2001, by the following vote: Yeas 146, Nays 1, 2 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 2600 on May 25, 2001, by the following vote: Yeas 134, Nays 8,
2 present, not voting.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 2600 was passed by the Senate, with
amendments, on May 18, 2001, by the following vote: Yeas 25, Nays
5, 1 present, not voting.
_______________________________
Secretary of the Senate
APPROVED: __________________________
Date
__________________________
Governor