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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