LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 77th Regular Session March 5, 2001 TO: Honorable Kim Brimer, Chair, House Committee on Business & Industry FROM: John Keel, Director, Legislative Budget Board IN RE: HB1202 by Brimer (Relating to the medical review of health care provided under the workers' compensation insurance system.), As Introduced ************************************************************************** * Estimated Two-year Net Impact to General Revenue Related Funds for * * HB1202, As Introduced: positive impact of $0 through the biennium * * ending August 31, 2003. * * * * The bill would make no appropriation but could provide the legal * * basis for an appropriation of funds to implement the provisions of * * the bill. * ************************************************************************** General Revenue-Related Funds, Five-Year Impact: **************************************************** * Fiscal Year Probable Net Positive/(Negative) * * Impact to General Revenue Related * * Funds * * 2002 $0 * * 2003 0 * * 2004 0 * * 2005 0 * * 2006 0 * **************************************************** All Funds, Five-Year Impact: ************************************************************************** *Fiscal Probable Probable Revenue Change in Number of * * Year Savings/(Cost) from Gain/(Loss) from State Employees from * * General Revenue Fund General Revenue Fund FY 2001 * * 0001 0001 * * 2002 $(416,929) $416,929 0.4 * * 2003 (769,529) 769,529 0.4 * * 2004 (769,529) 769,529 0.4 * * 2005 (769,529) 769,529 0.4 * * 2006 (769,529) 769,529 0.4 * ************************************************************************** Technology Impact The Texas Workers' Compensation Commission, the Texas Board of Medical Examiners, the Texas Board of Podiatric Medical Examiners, and the Texas Board of Chiropractic Examiners would need to make minor modifications to databases to collect and maintain doctor status on the Approved Doctor List. Fiscal Analysis The bill would amend Section 408.023 of the Labor Code by changing the way Texas Workers' Compensation Commission (TWCC) creates and maintains the Approved Doctors List (ADL) for treatment of workers' compensation claimants. The bill would require TWCC to register and provide certificates to doctors included on the ADL by March 2002. The bill would require TWCC to adopt rules and criteria for doctors receiving certification in four different categories: treating doctor, designated doctor, peer review doctor, and utilization review doctor. The bill would also authorize TWCC to impose sanctions on doctors, including removal from the ADL. The bill would also create a full-time position for Medical Advisor and a Medical Quality Review Panel. The Medical Advisor would be responsible for setting standards and guidelines, reviewing compliance, and recommending doctors for deletion from the ADL. The Medical Quality Review Panel would assist the Medical Advisor in making recommendations of doctors to be deleted from the ADL, as well as doctors to be added or suspended from the list. The bill would take effect September 1, 2001. Methodology TWCC estimates a one-time cost of $25,000 for mail notification to all 85,000 doctors in Texas for notification of the change in law. The agency estimates twelve quality of care doctor audits each year at a cost of $12,000 per audit. Also, the agency estimates increased disputes from doctors challenging audit findings and modifications to a doctor's status on the ADL. These disputes are estimated to cost $47,200 each, including expert testimony, peer medical review of files, charges at the State Office of Administrative Hearings, and deposition costs. It is estimated approximately five disputes would be brought in the first year, and thirteen each year thereafter. The Medical Advisor position already exists on a part-time basis, and the bill would require that position to be increased to a full-time position. It is assumed TWCC would be adjust the Workers' Compensation Maintenance Tax rate to offset any costs associated with the implementation of the bill Local Government Impact No fiscal implication to units of local government is anticipated. Source Agencies: 503 Texas State Board of Medical Examiners, 453 Texas Workers' Compensation Commission, 478 Research and Oversight Council on Workers' Compensation, 508 Texas Board of Chiropractic Examiners, 512 Texas State Board of Podiatric Medical Examiners LBB Staff: JK, JO, RT, KM