C.S.S.B. 1804 78(R)    BILL ANALYSIS


C.S.S.B. 1804
By: Harris
Business & Industry
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

Currently, a health care provider may contact an insurance carrier to get
precertification or preauthorization for certain care.  After receiving
the preauthorization or precertification from the carrier, the services
will be provided and billed to the insurance carrier.  Later, however, the
insurance carrier may dispute the treatment and services provided or
refuse to pay them.  This bill would clarify this section of the law. 

The bill also amends the section to add that the Texas Worker's
Compensation Commission may not prohibit the discussion of pharmaceutical
services between an insurance carrier and a health care provider.  


RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency, or
institution. 

ANALYSIS

SECTION 1.  Amends Section 413.014(e), Labor Code, to prohibit 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.  Effective date:  September 1, 2003; applicable to voluntary
precertification requests occurring on or after the effective date. 


EFFECTIVE DATE

September 1, 2003


COMPARISON OF ORIGINAL TO SUBSTITUTE

The original bill provided for an alternative dispute resolution process
and a modification in the filing of statements for supplemental benefits.
The substitute deleted these provisions.