By:  Giddings (Senate Sponsor - Carona)                           H.B. No. 3168
	(In the Senate - Received from the House May 12, 2003; 
May 13, 2003, read first time and referred to Committee on State 
Affairs; May 23, 2003, reported adversely, with favorable 
Committee Substitute by the following vote:  Yeas 6, Nays 0; 
May 23, 2003, sent to printer.)


COMMITTEE SUBSTITUTE FOR H.B. No. 3168                                   By:  Armbrister


A BILL TO BE ENTITLED

AN ACT


relating to the determination of workers' compensation benefits and 
the resolution of disputes regarding those benefits.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 413.031, Labor Code, is amended by 
amending Subsection (e) and adding Subsection (m) to read as 
follows:
	(e)  Except as provided by Subsections [Subsection] (d), 
(f), and (m), a review of the medical necessity of a health care 
service provided under this chapter or Chapter 408 shall be 
conducted by an independent review organization under Article 
21.58C, Insurance Code, in the same manner as reviews of 
utilization review decisions by health maintenance organizations.  
It is a defense for the insurance carrier if the carrier timely 
complies with the decision of the independent review organization.
	(m)  The commission by rule may prescribe an alternate 
dispute resolution process to resolve disputes regarding medical 
services costing less than the cost of a review of the medical 
necessity of a health care service by an independent review 
organization.  The cost of a review under the alternate dispute 
resolution process shall be paid by the nonprevailing party.
	SECTION 2.  Section 408.123, Labor Code, is amended by 
adding Subsections (d)-(g) to read as follows:
	(d)  Except as otherwise provided by this section, an 
employee's first valid certification of maximum medical 
improvement and first valid assignment of an impairment rating is 
final if the certification or assignment is not disputed before the 
91st day after the date written notification of the certification 
or  assignment is provided to the employee and the carrier by 
verifiable means.
	(e)  An employee's first certification of maximum medical 
improvement or assignment of an impairment rating may be disputed 
after the period described by Subsection (d) if:
		(1)  compelling medical evidence exists of:                            
			(A)  a significant error by the certifying doctor 
in applying the appropriate American Medical Association 
guidelines or in calculating the impairment rating;
			(B)  a clearly mistaken diagnosis or a previously 
undiagnosed medical condition;  or
			(C)  improper or inadequate treatment of the 
injury before the date of the certification or assignment that 
would render the certification or assignment invalid; or
		(2)  other compelling circumstances exist as 
prescribed by commission rule.
	(f)  If an employee has not been certified as having reached 
maximum medical improvement before the expiration of 104 weeks 
after the date income benefits begin to accrue or the expiration 
date of any extension of benefits under Section 408.104, the 
impairment rating assigned after the expiration of either of those 
periods is final if the impairment rating is not disputed before the 
91st day after the date written notification of the certification 
or assignment is provided to the employee and the carrier by 
verifiable means.  A certification or assignment may be disputed 
after the 90th day only as provided by Subsection (e).
	(g)  If an employee's disputed certification of maximum 
medical improvement or assignment of impairment rating is finally 
modified, overturned, or withdrawn, the first certification or 
assignment made after the date of the modification, overturning, or 
withdrawal becomes final if the certification or assignment is not 
disputed before the 91st day after the date notification of the 
certification or assignment is provided to the employee and the 
carrier by verifiable means.  A certification or assignment may be 
disputed after the 90th day only as provided by Subsection (e).
	SECTION 3.  The change in law made by this Act by the 
amendment of Section 408.123, Labor Code, applies only to a 
certification of maximum medical improvement and assignment of an 
impairment rating that is made on or after the effective date of 
this Act.  A certification of maximum medical improvement or 
assignment of an impairment rating that is made before the 
effective date of this Act is governed by the law in effect on the 
date the certification or assignment was made, and the former law  
is continued in effect for that purpose.
	SECTION 4.  This Act takes effect immediately if it receives 
a vote of two-thirds of all the members elected to each house, as 
provided by Section 39, Article III, Texas Constitution.  If this 
Act does not receive the vote necessary for immediate effect, this 
Act takes effect September 1, 2003.



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