S.B. No. 1804




AN ACT

relating to certain health care treatment plans and pharmaceutical 
services and to medical necessity reviews.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subsection (e), Section 413.014, Labor Code, is 
amended to read as follows:
	(e)  The commission may not prohibit an insurance carrier and 
a health care provider from voluntarily discussing health care 
treatment and treatment plans and pharmaceutical services, either 
prospectively or concurrently, and may not prohibit an insurance 
carrier from certifying or agreeing to pay for health care 
consistent with those agreements.  The insurance carrier is liable 
for health care treatment and treatment plans and pharmaceutical 
services that are voluntarily preauthorized and may not dispute the 
certified or agreed-on preauthorized health care treatment and 
treatment plans and pharmaceutical services at a later date.
	SECTION  2.  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 3.  This Act takes effect September 1, 2003, and 
applies to requests for voluntary precertification occurring on, or 
after, the effective date.

                                                                              




______________________________    ______________________________
President of the Senate             Speaker of the House
	I hereby certify that S.B. No. 1804 passed the Senate on 
May 8, 2003, by the following vote:  Yeas 31, Nays 0; and that the 
Senate concurred in House amendments on May 31, 2003, by a 
viva-voce vote.




______________________________ 
   Secretary of the Senate             
	I hereby certify that S.B. No. 1804 passed the House, with 
amendments, on May 28, 2003, by a non-record vote.




______________________________ 
   Chief Clerk of the House            



Approved:


______________________________ 
            Date



______________________________ 
          Governor