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A BILL TO BE ENTITLED
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AN ACT
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relating to physician licensing requirements for utilization |
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review of medical decisions regarding workers' compensation |
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claims. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 408.023(h), Labor Code, is amended to |
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read as follows: |
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(h) Notwithstanding Section 4201.152 [4(h), Article
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21.58A], Insurance Code, a utilization review agent that uses |
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doctors to perform reviews of health care services provided under |
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this subtitle may only use doctors licensed [by another state to
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perform the reviews, but the reviews must be performed under the
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direction of a doctor licensed] to practice in this state. |
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SECTION 2. Section 408.0231(e), Labor Code, is amended to |
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read as follows: |
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(e) The commissioner shall act on a recommendation by the |
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medical advisor selected under Section 413.0511 and, after notice |
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and the opportunity for a hearing, may impose sanctions under this |
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section on a doctor or an insurance carrier or may recommend action |
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regarding a utilization review agent. The commissioner and the |
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commissioner of insurance shall enter into a memorandum of |
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understanding to coordinate the regulation of insurance carriers |
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and utilization review agents as necessary to ensure: |
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(1) compliance with applicable regulations; and |
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(2) that appropriate health care decisions are reached |
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under this subtitle and under Chapter 4201 [Article 21.58A], |
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Insurance Code. |
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SECTION 3. (a) Sections 4201.054(a) and (d), Insurance |
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Code, as effective April 1, 2007, are amended to conform to Section |
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6.072, Chapter 265, Acts of the 79th Legislature, Regular Session, |
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to read as follows: |
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(a) Except as provided by this section, this chapter applies |
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to utilization review of a health care service provided to a person |
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eligible for workers' compensation medical benefits under Title 5, |
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Labor Code. The commissioner of workers' compensation shall |
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regulate as provided by this chapter a person who performs |
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utilization review of a medical benefit provided under Title 5 |
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[Chapter 408], Labor Code. |
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(d) The commissioner of workers' compensation [and the
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Texas Workers' Compensation Commission] may adopt rules [and enter
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into memoranda of understanding] as necessary to implement this |
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section. |
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(b) Section 4201.054(b), Insurance Code, is repealed to |
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conform to Section 6.072, Chapter 265, Acts of the 79th |
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Legislature, Regular Session, 2005. |
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(c) Section 6.072, Chapter 265, Acts of the 79th |
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Legislature, Regular Session, 2005, is repealed. |
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SECTION 4. (a) Section 4201.207(b), Insurance Code, as |
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effective April 1, 2007, is amended to conform to Section 6.071, |
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Chapter 265, Acts of the 79th Legislature, Regular Session, 2005, |
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to read as follows: |
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(b) A health care provider's charges for providing medical |
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information to a utilization review agent may not: |
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(1) exceed the cost of copying records regarding a |
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workers' compensation claim as set by rules adopted by the |
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commissioner of workers' compensation [Texas Workers' Compensation
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Commission]; or |
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(2) include any costs otherwise recouped as part of |
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the charges for health care. |
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(b) Section 6.071, Chapter 265, Acts of the 79th |
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Legislature, Regular Session, 2005, is repealed. |
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SECTION 5. 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 6. To the extent of any conflict, this Act prevails |
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over another Act of the 80th Legislature, Regular Session, 2007, |
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relating to nonsubstantive additions to and corrections in enacted |
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codes. |
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SECTION 7. This Act takes effect September 1, 2007. |