By: Harris S.B. No. 1804
(In the Senate - Filed March 14, 2003; March 24, 2003, read
first time and referred to Committee on State Affairs;
April 30, 2003, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 7, Nays 0; April 30, 2003,
sent to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 1804 By: Harris
A BILL TO BE ENTITLED
AN ACT
relating to the resolution of certain medical disputes and certain
other procedures in connection with workers' compensation
benefits.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsection (b), Section 408.143, Labor Code, is
amended to read as follows:
(b) The statement required under this section must be filed
[quarterly] on a form and in the manner provided by the commission.
The commission may modify the filing period as appropriate to an
individual case. Unless modified by the commission, the statement
shall be filed quarterly until the first anniversary of the date of
the commission's initial determination of supplemental benefits
and, after that date, the statement shall be filed every six months
if supplemental benefits were provided continuously during that
first year.
SECTION 2. Subsection (b), Section 408.151, Labor Code, is
amended to read as follows:
(b) If a dispute exists as to whether the employee's medical
condition has improved sufficiently to allow the employee to return
to work, the commission shall direct the employee to be examined by
a designated doctor chosen by the commission. In addition to
determining whether the employee's medical condition has improved,
the examination must include a determination of the type of
employment the employee is physically or medically able to perform.
The designated doctor shall report to the commission. The report of
the designated doctor has presumptive weight, and the commission
shall base its determination of whether the employee's medical
condition has shown improved functional gain [sufficiently] to
allow the employee to return to work on that report unless the great
weight of the other medical evidence is to the contrary.
SECTION 3. Subchapter C, Chapter 413, Labor Code, is
amended by adding Section 413.032 to read as follows:
Sec. 413.032. ALTERNATIVE MEDICAL DISPUTE RESOLUTION
PROCESS. (a) The commission shall evaluate the effectiveness and
costs of the medical dispute resolution process under Section
413.031 and study proposals for the establishment of an alternative
process. In performing the study and proposing an alternative
medical dispute resolution process, the commission shall emphasize
the establishment of a process that is less expensive than the
current system.
(b) In performing the commission's duties under this
section, the commission shall solicit the participation of persons
who represent the interests of employees, employers, health care
providers, insurance carriers, governmental agencies, and others
who may be interested in the results of the study.
(c) The commission shall report the results of the study
under this section, including the commission's proposal for an
alternative medical dispute resolution process, to the lieutenant
governor and speaker of the house of representatives not later than
December 1, 2004.
(d) This section expires January 1, 2006.
SECTION 4. 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 5. (a) This Act takes effect September 1, 2003.
(b) The changes in law made by this Act by the amendment of
Sections 408.143, 408.151, and 413.014, Labor Code, apply only to a
claim for workers' compensation benefits based on a compensable
injury that occurs on or after the effective date of this Act. A
claim based on a compensable injury that occurs before the
effective date of this Act is governed by the law in effect on the
date the compensable injury occurred, and the former law is
continued in effect for that purpose.
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