SRC-JEC S.B. 1804 78(R)BILL ANALYSIS


Senate Research CenterS.B. 1804
By: Harris
State Affairs
6/27/2003
Enrolled


DIGEST AND PURPOSE 

S.B. 1804 addresses the issue of an insurance carrier preauthorizing, and
later disputing, health care services or pharmaceuticals, by making the
carrier liable for the voluntarily preauthorized care. Additionally, S.B.
1804 modifies provisions regarding an independent review of medical
necessity in workers' compensation cases. 

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 Subsection (e), Section 413.014, Labor Code, to
prohibit the Texas Workers' Compensation Commission (TWCC) from
prohibiting an insurance carrier and a health care provider from
voluntarily discussing pharmaceutical services, either prospectively or
concurrently. Provides that the insurance carrier is liable for health
care treatment and treatment plans and pharmaceutical services that are
voluntarily preauthorized and prohibits the insurance carrier from
disputing the certified or agreed-upon preauthorized health care treatment
and treatment plans and pharmaceutical services at a later date. 

SECTION 2.  Amends Section 413.031, Labor Code, by adding Subsection
(e-1), to require an independent review organization, in performing a
review of medical necessity under Subsection (d) or (e), to consider
TWCC's 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.  Provides that if the independent review
organization's decision is contrary to TWCC's policies or guidelines
adopted under Section 413.011, the independent review organization is
required to indicate in the decision the specific basis for its divergence
in the review of medical necessity.  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 those policies are raised by a party to the dispute. 

SECTION  3.  Effective date:  September 1, 2003.
Makes application of this Act to requests for voluntary precertification
prospective.