| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
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 [are inconsistent with] the fee |
|
|
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) [if] the insurance carrier or a network under |
|
|
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. |