By:  Carona                                                       S.B. No. 1573
	(In the Senate - Filed March 14, 2003; March 20, 2003, read 
first time and referred to Committee on State Affairs; May 5, 2003, 
reported adversely, with favorable Committee Substitute by the 
following vote:  Yeas 8, Nays 0; May 5, 2003, sent to printer.)


COMMITTEE SUBSTITUTE FOR S.B. No. 1573                                   By:  Nelson


A BILL TO BE ENTITLED

AN ACT


relating to the applicability of certain policies and guidelines 
adopted by the Texas Workers' Compensation Commission to medical 
dispute resolution under the workers' compensation system.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 413.031, Labor Code, is amended by 
adding Subsection (e-1) to read as follows:
	(e-1)  In performing a review of medical necessity under 
Subsection (d) or (e), the independent review organization shall 
consider the commission'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.  If the 
independent review organization's decision is contrary to the 
commission's policies or guidelines adopted under Section 413.011, 
the independent review organization must indicate in the decision 
the specific basis for its divergence in the review of medical 
necessity.  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 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.



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