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A BILL TO BE ENTITLED
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AN ACT
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relating to professional licensing requirements for independent |
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review of certain medical decisions regarding workers' |
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compensation claims. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 413.031, Labor Code, is amended by |
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amending Subsections (d) and (e) and adding Subsection (e-2) to |
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read as follows: |
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(d) A review of the medical necessity of a health care |
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service requiring preauthorization under Section 413.014 or |
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commissioner rules under that section or Section 413.011(g) shall |
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be conducted by an independent review organization under Chapter |
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4202 [Article 21.58C], Insurance Code, in the same manner as |
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reviews of utilization review decisions by health maintenance |
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organizations. It is a defense for the insurance carrier if the |
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carrier timely complies with the decision of the independent review |
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organization. |
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(e) Except as provided by Subsections (d), (f), and (m), a |
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review of the medical necessity of a health care service provided |
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under this chapter or Chapter 408 shall be conducted by an |
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independent review organization under Chapter 4202 [Article
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21.58C], Insurance Code, in the same manner as reviews of |
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utilization review decisions by health maintenance organizations. |
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It is a defense for the insurance carrier if the carrier timely |
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complies with the decision of the independent review organization. |
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(e-2) Notwithstanding Section 4202.002, Insurance Code, an |
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independent review organization that uses doctors to perform |
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reviews of health care services provided under this title may only |
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use doctors licensed to practice in this state. |
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SECTION 2. The change in law made by this Act applies only |
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to a claim for workers' compensation benefits based on a |
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compensable injury that occurs on or after the effective date of |
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this Act. A claim based on a compensable injury that occurs before |
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that date is governed by the law in effect on the date that the |
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compensable injury occurred, and the former law is continued in |
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effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2007. |