SRC-JEC S.B. 1576 78(R) BILL ANALYSIS
Senate Research Center S.B. 1576
By: Carona
State Affairs
4/8/2003
As Filed
DIGEST AND PURPOSE
The Health Care Network Advisory Committee concluded in a study pursuant
to H.B. 2600, 77th Legislature, that the regional network model of health
care delivery is feasible, assuming certain rates of participation by
state employees. As proposed, S.B. 1576 establishes a pilot project for
the regional network model for state employees in Austin, San Antonio, and
Houston.
RULEMAKING AUTHORITY
This bill does not directly grant any additional rulemaking authority to a
state officer, institution, or agency.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 408.0221, Labor Code, as follows:
(a) Redefines "regional network" to include "pilot project." Defines
"pilot project."
(b) Authorizes the regional networks established under this section to
offer select health care services in addition to a full range of health
care services.
(c) Charges the Health Care Network Advisory Committee (HCNAC) with the
responsibility of monitoring and overseeing the implementation of the
regional network pilot project and regional networks participating in the
pilot project. Amends the membership of the HCNAC to include a member
representing the Texas Mutual Insurance Company, rather than the Texas
Workers' Compensation Insurance Fund.
(d) Deletes provisions requiring the Texas Workers' Compensation
Commission (TWCC) to establish and contract with regional networks for the
provision of health care under this subtitle and providing that the
provision of health care under this subtitle shall not apply to
prescription medication or services.
(h) Requires TWCC, on behalf of and at the direction of HCNAC, to enter
into an interagency contract with another state agency or state university
with a proven research capacity to product all or part of the regional
network report card. Requires initial funding to produce or oversee
production of the report card to be provided by the subsequent injury fund
as described in Subsection (l). Authorizes TWCC or another state agency
under interagency contract with the commission to procure services as
necessary to produce the report card. Requires ongoing costs associated
with the production of report cards to be funded either by assessments on
networks participating in the pilot project or to be included in the fees
for health care services paid by insurance carriers participating in the
regional network pilot project. Deletes a requirement that the report card
be based on contracted reviews.
(i) Establishes a pilot project, provided that the feasibility study
described in Subsection (b) concludes that regional networks may be
feasible, to analyze the ability of networks created under the standards
developed by the advisory committee to improve the quality and reduce the
costs of health care provided to employees of employers participating in
the pilot project. Authorizes HCNAC to initiate the pilot project in a
designated geographic region or regions. Requires certain state agencies
and entities, on or before November 1, 2003, through competitive
procurement, to contract with one or more regional networks for the
provision of health care under this subtitle as part of the pilot project.
Provides that, for the purposes of this section and Section 408.0222, the
pilot project is initiated on the date that employees begin to receive
medical care in the network, and unless continued by statute, ends three
years from that date. Requires a network that contracts with a public
employer covered under Subtitle C of this title to meet the network
standards and report card requirements established by HCNAC. Sets a
November 1 annual deadline for submission of consolidated annual reports
by regional network administrators. Requires the Research and Oversight
Council on Workers' Compensation to report to the legislature by February
1, 2005, rather than January 1 of each odd-numbered year, on the status of
the regional network pilot project, rather than the implementation of
regional networks, under this section. Makes conforming changes.
(j) Makes conforming changes.
(k) Requires TWCC, on behalf of HCNAC, to collect and attempt to resolve
any complaints filed by pilot project participants regarding the regional
network pilot project. Requires TWCC to make available any complaints
filed, along with a description of their resolution, to HCNAC, to those
entities producing the network report card, and to the Research and
Oversight Council on Workers' Compensation on a quarterly basis.
(l) Redesignated from (k). Sets forth the option for the cost of ongoing
regional network administration and management services and report card
administration to be assessed on networks participating in the pilot
project, rather than only being required to be included in the fees for
health care services paid by insurance carriers participating in the
regional network. Makes conforming changes.
(m) Redesignated from (l). Deletes reference to consultation with
actuaries in compiling the annual reports submitted under Subsection (i).
Requires cost savings information to be submitted as part of the annual
report. Requires the regional networks to contract with independent
actuaries or financial advisors to produce this determination if required
to do so by the regional network contract or the standards adopted under
Section 408.0221. Requires HCNAC, on receipt of the first annual report
from the networks in the pilot project, to decide whether to expand the
pilot project to include insurance carriers not listed in Subsection (i).
Requires TWCC, on behalf of HCNAC if HCNAC chooses to expand the pilot
project to include other insurance carriers, through competitive
procurement to contract with regional networks for the provision of health
care for those insurance carriers not listed in Subsection (i). Authorizes
an insurance carrier not listed in Subsection (i) to elect to participate
or not, by contract, in the pilot project established by this section.
(n) Authorizes, but does not require, the regional network pilot project
to comply with certain statutory provisions of the Labor Code, and related
TWCC rules.
(o) Requires the applicability of the statutory and rule provisions in
Subsection (n) to be determined through the contract negotiations
described in this section.
SECTION 2. Amends Section 408.0222, Labor Code, as follows:
Sec. 408.0222. New heading: PARTICIPATION IN REGIONAL NETWORK PILOT
PROJECT; SELECTION OF DOCTOR WITHIN REGIONAL NETWORK; BENEFIT INCENTIVES.
(a) Makes conforming changes.
(b) Makes a conforming change. Redesignated from Subsection (c).
(c) Redesignated from Subsection (d). Makes an employee's election to
participate in the network effective for all medical care related to an
injury occurring on or after the date the insurance carrier begins to
participate in the pilot project. Makes conforming changes.
(d) Redesignated from Subsection (e). Makes conforming changes.
(e) Redesignated from Subsection (f). Makes conforming changes.
(f) Redesignated from Subsection (g). Makes conforming changes.
(g) Redesignated from Subsection (h).
(h) Redesignated from Subsection (i). Makes conforming changes.
(i) Redesignated from Subsection (j). Provides that Subsection (h) does
not authorize a cause of action or damages against the state, a state
agency, or an employee of the state beyond the actions and damages
authorized by Chapter 101 (Tort Claims), Civil Practice and Remedies Code.
Makes conforming changes.
(j) Redesignated from Subsection (k). Makes conforming changes.
(k) Redesignated from Subsection (l). Makes conforming changes.
(l) Redesignated from Subsection (m).
(m) Redesignated from Subsection (n). Makes conforming changes.
(n) Redesignated from Subsection (o). Makes conforming changes.
(o) Redesignated from Subsection (p).
(p) Redesignated from Subsection (q). Makes conforming changes.
(q) Redesignated from Subsection (r). Makes conforming changes.
(r) Redesignated from Subsection (s).
(s) Redesignated from Subsection (t).
(t) Redesignated from Subsection (u). Provides that the selection of a
doctor because the original doctor becomes unwilling to provide medical
care to the employee is not considered a selection of an alternate doctor
in a regional network established under Section 408.0221.
SECTION 3. Amends Section 408.023, Labor Code, as follows:
(d) Makes conforming changes.
(e) Requires TWCC, on behalf of HCNAC, to adopt rules, as necessary, to
implement additional standards for insurance carrier networks.
Effective date: On the 91st day after the date of final adjournment.
[S.B. 1576, as drafted, has no effective date.]