SRC-LBB S.B. 1573 78(R)   BILL ANALYSIS


Senate Research Center   S.B. 1573
By: Carona
State Affairs
4/4/2003
As Filed


DIGEST AND PURPOSE 

Currently, Texas Workers' Compensation Commission (TWCC) rules allow any
medical service to be disputed through the medical dispute resolution
process.  TWCC rules do not require an independent review organization
(IRO) that hears a dispute to consider the TWCC payment policies in
resolving a dispute.  As proposed, S.B. 1573 requires the IRO to consider
TWCC payment policies and guidelines, if the policies and guidelines are
raised by one of the parties to the dispute.  This bill also requires an
IRO to state the specific basis for its divergence in the review of
medical necessity, if the IRO's decision is contrary to TWCC's policies or
guidelines. 

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to
a state officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 413.031(e), Labor Code, to require the
independent review organization, in performing a review of medical
necessity under Subsection (d) or this subsection, to consider the Texas
Workers' Compensation Commission's (TWCC)  health care reimbursement
policies and guidelines adopted under Section 413.011, if these policies
and guidelines are raised by one of the parties to the dispute.  Requires
the decision to indicate the specific basis for its divergence in the
review of medical necessity, if the independent review organization's
decision is contrary to TWCC's policies or guidelines.  Provides that this
section does not prohibit an independent review organization from
considering the payment policies adopted under Section 413.011 in any
dispute, regardless of whether these policies are raised by a party to the
dispute.  

SECTION 2.  Effective date:  upon passage or September 1, 2003.

SECTION 3.  Makes application of this Act prospective.