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A BILL TO BE ENTITLED
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AN ACT
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relating to the application of certain fee guidelines to health |
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care provided under the workers' compensation system. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 413.011(d), Labor Code, is amended to |
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read as follows: |
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(d) Fee guidelines must be fair and reasonable and designed |
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to ensure the quality of medical care and to achieve effective |
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medical cost control. The guidelines may not provide for payment of |
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a fee in excess of the fee charged for similar treatment of an |
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injured individual of an equivalent standard of living and paid by |
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that individual or by someone acting on that individual's behalf. |
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The commissioner shall consider the increased security of payment |
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afforded by this subtitle in establishing the fee guidelines. |
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Notwithstanding Section 413.016 or any other provision of this |
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title, to secure health care for an injured employee an insurance |
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carrier may pay fees to a health care provider that exceed the fees |
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adopted by the division under [are inconsistent with] the fee |
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guidelines if: |
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(1) access to medically necessary and reasonable |
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treatment for the injured employee is hindered by application of |
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the fee guidelines adopted by the division; and |
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(2) [if] the insurance carrier or a network under |
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Chapter 1305, Insurance Code, has a contract with the health care |
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provider and that contract includes a specific fee schedule. |
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SECTION 2. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2007. |
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COMMITTEE AMENDMENT NO. 1 |
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Amend H.B. 473 on page 1, line 24, after "Chapter 1305, |
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Insurance Code," by inserting "arranging out-of-network services," |
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Elkins |