Amend CSHB 7 as follows:
(1) On page 12, between lines 19 and 20, insert the
following:
(44-a) "URAC" means the Utilization Review
Accreditation Committee of the American Accreditation Healthcare
Commission, Inc.
(2) On page 115, line 19, between "compensable injury" and
the semicolon, insert ", including the relief of pain".
(3) On page 120, strike lines 3-7 and substitute the
following:
"medical condition. The designated doctor doing the review
must hold the same type of professional license that the treating
doctor holds [be trained and experienced with the treatment and
procedures used by the doctor treating the patient's medical
condition, and the treatment and procedures performed must be
within the scope of practice of the designated doctor]. The
department [commission]".
(4) On page 125, line 11, insert the following after the
period:
"The commissioner shall monitor pharmaceutical costs and the
utilization of pharmaceutical services.".
(5) On page 128, line 7, strike "65th" and substitute "45th".
(6) On page 128, strike line 10 and substitute the following:
"time during the 45-day period. The payment shall be made in a
manner consistent with the prompt pay requirements under Chapter
1301, Insurance Code. If the insurance carrier requests".
(7) On page 128, line 20, strike "65th" and substitute
"45th".
(8) On page 128, line 23, strike "160th" and substitute
"90th".
(9) On page 128, line 25, strike "160th" and substitute
"90th".
(10) On page 129, line 19, strike "65th" and substitute
"45th".
(11) On page 129, line 23, strike "160th" and substitute
"90th".
(12) On page 130, line 16, strike "65th" and substitute
"45th".
(13) On page 143, line 8, insert the following after the
period:
"The department shall accept applications only from those
carriers, networks, and individuals that are URAC accredited or are
accredited by a similar national organization recognized by the
commissioner.".
(14) On page 145, line 27, strike "is not required" and
substitute "is required".
(15) On page 146, line 3, strike "for participation if the
provider network" and substitute "for participation even if the
provider network".
(16) On page 169, line 13, between "Insurance Code" and the
period, insert the following:
", and must be URAC accredited or accredited by a similar
national organization recognized by the commissioner".
(17) On page 170, strike lines 14-19 and substitute the
following:
"(F) ensuring that providers used by the provider
network to perform utilization review:
(i) meet the provider network's
credentialing standards;
(ii) are appropriately trained to perform
utilization review in accordance with Section 408B.354;
(iii) hold the same type of professional
license as the treating doctor; and
(iv) are licensed in this state;".
(18) On page 172, line 7, insert the following after the
period:
"Retrospective review must be performed by a doctor who:
(1) holds the same type of professional license as the
treating doctor; and
(2) is licensed in this state.".
(19) On page 187, strike lines 14-16 and substitute the
following:
"Sec. 408C.007. PREAUTHORIZATION; UTILIZATION REVIEW. (a)
All health care services must be preauthorized except for emergency
care. A health care provider is guaranteed payment for a
preauthorized health care service provided by the health care
provider.".
(20) On page 196, line 14, strike "under the provider
network" and substitute "who holds the same type of professional
license as the treating doctor".
(21) On page 285, strike lines 21-22 and substitute the
following:
"SECTION 1.523. Section 413.0512, Labor Code, is amended by
amending Subsections (a), (c), and (d) and by adding Subsection (e)
to read as follows:".
(22) On page 286, between lines 21 and 22, insert the
following:
"(e) While a person is serving on the medical quality review
panel, the person must be in full-time active professional
practice. The person may not receive any compensation for the
performance of utilization reviews."