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


Senate Research CenterC.S.S.B. 1573
78R14422 PB-FBy: Carona
State Affairs
5/2/2003
Committee Report (Substituted)


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.  C.S.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, Labor Code, by adding Subsection
(e-1), to require the independent review organization, in performing a
review of medical necessity under Subsection (d) or Subsection (e), to
consider the Texas Workers' Compensation Commission's (TWCC) health care
reimbursement policies and guidelines adopted under Section 413.011, if
those policies and guidelines are raised by one of the parties to the
dispute.  Requires the independent review organization to indicate in its
decision 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 adopted under Section 413.011.  Provides
that this subsection 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.