80R453 PB-D | ||
By: Solomons | H.B. No. 473 | |
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relating to the application of certain fee guidelines to health | |||
care provided under the workers' compensation system. | |||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | |||
SECTION 1. Section 413.011(d), Labor Code, is amended to | |||
read as follows: | |||
(d) Fee guidelines must be fair and reasonable and designed | |||
to ensure the quality of medical care and to achieve effective | |||
medical cost control. The guidelines may not provide for payment of | |||
a fee in excess of the fee charged for similar treatment of an | |||
injured individual of an equivalent standard of living and paid by | |||
that individual or by someone acting on that individual's behalf. | |||
The commissioner shall consider the increased security of payment | |||
afforded by this subtitle in establishing the fee guidelines. | |||
Notwithstanding Section 413.016 or any other provision of this | |||
title, to secure health care for an injured employee an insurance | |||
carrier may pay fees to a health care provider that exceed the fees | |||
adopted by the division under [ |
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guidelines if: | |||
(1) access to medically necessary and reasonable | |||
treatment for the injured employee is hindered by application of | |||
the fee guidelines adopted by the division; and | |||
(2) [ |
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Chapter 1305, Insurance Code, has a contract with the health care | |||
provider and that contract includes a specific fee schedule. | |||
SECTION 2. This Act takes effect immediately if it receives | |||
a vote of two-thirds of all the members elected to each house, as | |||
provided by Section 39, Article III, Texas Constitution. If this | |||
Act does not receive the vote necessary for immediate effect, this | |||
Act takes effect September 1, 2007. | |||
COMMITTEE AMENDMENT NO. 1 | |||
Amend H.B. 473 on page 1, line 24, after "Chapter 1305, | |||
Insurance Code," by inserting "arranging out-of-network services," | |||
Elkins |