BILL ANALYSIS
By: Giddings
Committee Report (Substituted)
BACKGROUND AND PURPOSE
A provider of care for a workers' compensation injury forfeits his or her right to reimbursement if the claim for payment is filed later than the 95th day after the date the health care services were provided. In some cases, a doctor treating a workers' compensation injury will bill the wrong insurance carrier - either the employee's group health carrier or the incorrect workers compensation insurance carrier. By the time the mistake has been discovered, and the claim is re-filed with the right carrier, the deadline may have passed, and the workers' compensation insurance carrier may deny payment.
C.S.H.B. 1005 provides that a health care provider of workers' compensation health care services does not forfeit his or her right to reimbursement if the claim for payment is timely filed, but erroneously filed with the wrong insurer. The bill also allows extension of the deadline by agreement of the parties or in catastrophic situations.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
ANALYSIS
C.S.H.B. 1005 amends the Labor Code to provide that a health care provider who fails to timely submit a claim for payment does not forfeit payment solely for failure to submit a timely claim to the insurance carrier if the provider submits proof satisfactory to the commissioner of workers' compensation, within the prescribed period, that the provider erroneously filed for reimbursement with the insurer that issues a policy of group accident and health insurance under which the injured employee is a covered insured; with a health maintenance organization that issues an evidence of coverage under which the injured employee is a covered enrollee; or with a workers' compensation insurance carrier other than the insurance carrier liable for the payment of benefits. The provider who erroneously submits a claim forfeits the provider's right to reimbursement for that claim if the provider fails to submit the claim to the correct workers' compensation insurance carrier within 95 days after the date the provider is notified of the provider's erroneous submission of the claim.
C.S.H.B. 1005 provides that failure by the health care provider to timely submit a claim for payment does not constitute a forfeiture of the provider's right to reimbursement for that claim for payment if the commissioner of workers' compensation determines that the failure resulted from a catastrophic event that substantially interfered with the normal business operations of the provider. The bill authorizes the period for submitting a claim for payment to be extended by agreement of the parties. The bill defines "group accident and health insurance" and "health maintenance organization."
C.S.H.B. 1005 provides that the changes in law of this Act apply to a claim for payment relating to health care services rendered on or after the effective date of this Act.
EFFECTIVE DATE
September 1, 2007.
COMPARISON OF ORIGINAL TO SUBSTITUTE
The substitute differs from the original by clarifying that a provider does not forfeit the provider's right to repayment due to erroneous submission to a health maintenance organization. as well as to a group accident and health insurer or workers' compensation insurer. The substitute specifies that the provider who erroneously submits a claim forfeits the provider's right to reimbursement for that claim if the provider fails to submit the claim to the correct workers' compensation insurance carrier within 95 days after the date the provider is notified of the provider's erroneous submission of the claim. The substitute authorizes the parties to extend the payment period by agreement, and allows the commissioner of workers' compensation to authorize payment of a claim that is late if the commissioner determines that the failure to submit in a timely manner resulted from a catastrophic event that substantially interfered with the normal business operations of the provider.
The substitute adds the definition of "health maintenance organization." The substitute changes the heading of the new section added by this Act from "Effect of Erroneous Submission of Claim to Group Accident and Health Insurer" to "Certain Exceptions for Untimely Submission of Claim."
The substitute makes the provisions of the Act apply to payment for health care services rendered on or after the effective date of the Act, rather than apply to payment for health care services for compensable injuries which occurred on or after the effective date of the Act.