By:  Carona                                                       S.B. No. 1573


A BILL TO BE ENTITLED

AN ACT

relating to the applicability of the medical reimbursement policies 
and guidelines of the Texas Workers' Compensation Commission to 
medical dispute resolution in the Texas workers' compensation 
system.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 413.031, Labor Code, is amended to read 
as follows:      
	Sec. 413.031.  MEDICAL DISPUTE RESOLUTION.  (e)  Except as 
provided by Subsection (d), 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.  
In performing a review of medical necessity under Subsection (d) or 
this subsection, the independent review organization shall 
consider the commission's health care reimbursement policies and 
guidelines adopted under Section 413.011, if these policies and 
guidelines are raised by one of the parties to the dispute.  If the 
independent review organization's decision is contrary to the 
commission's policies or guidelines, the decision shall indicate 
the specific basis for its divergence in the review of medical 
necessity.  This section 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.  It is a defense for 
the insurance carrier if the carrier timely complies with the 
decision of the independent review organization.
	SECTION 2.  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.
	SECTION 3.  The change in law made by this Act applies to a 
request for medical dispute resolution filed with the commission on 
or after the effective date of this Act.