80R6207 PB-D

By: Zedler H.B. No. 1285

A BILL TO BE ENTITLED

AN ACT

relating to accreditation requirements for certain workers' compensation insurers and self-insurers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter A, Chapter 1305, Insurance Code, is amended by adding Section 1305.0061 to read as follows:

Sec. 1305.0061. NATIONAL ACCREDITATION REQUIRED. (a) In this section, "URAC" means the Utilization Review Accreditation Committee of the American Accreditation Healthcare Commission, Inc.

(b) An insurance carrier that establishes or contracts with a network certified under this chapter to provide health care services under the Texas Workers' Compensation Act must present evidence satisfactory to the commissioner that the carrier is URAC-accredited or accredited by a similar national organization recognized by the commissioner.

SECTION 2. Subchapter A, Chapter 2051, Insurance Code, is amended by adding Section 2051.003 to read as follows:

Sec. 2051.003. NATIONAL ACCREDITATION REQUIRED. (a) In this section, "URAC" means the Utilization Review Accreditation Committee of the American Accreditation Healthcare Commission, Inc.

(b) An insurance company must present evidence satisfactory to the commissioner that the company is URAC-accredited or accredited by a similar national organization recognized by the commissioner. Failure by an insurance company to comply with the accreditation requirement under this subsection constitutes grounds for cancellation of the insurance company's certificate of authority.

SECTION 3. Subchapter A, Chapter 2054, Insurance Code, is amended by adding Section 2054.0041 to read as follows:

Sec. 2054.0041. NATIONAL ACCREDITATION REQUIRED. (a) In this section, "URAC" means the Utilization Review Accreditation Committee of the American Accreditation Healthcare Commission, Inc.

(b) The company must present evidence satisfactory to the commissioner that the carrier is URAC-accredited or accredited by a similar national organization recognized by the commissioner. Failure by the company to comply with the accreditation requirement under this subsection constitutes grounds for cancellation of the company's certificate of authority.

SECTION 4. Subchapter C, Chapter 406, Labor Code, is amended by adding Section 406.054 to read as follows:

Sec. 406.054. INSURANCE COMPANY ACCREDITATION. An insurance company that issues a workers' compensation insurance policy under this chapter must comply with Section 2051.003, Insurance Code, or Section 2054.0041, Insurance Code, as applicable.

SECTION 5. Chapter 406A, Labor Code, is amended by adding Section 406A.009 to read as follows:

Sec. 406A.009. NATIONAL ACCREDITATION REQUIRED. (a) In this section, "URAC" means the Utilization Review Accreditation Committee of the American Accreditation Healthcare Commission, Inc.

(b) To be eligible for a certificate of approval under this chapter, a group must present evidence satisfactory to the commissioner that the group is URAC-accredited or accredited by a similar national organization recognized by the commissioner. Failure by the group to comply with the accreditation requirement under this subsection constitutes grounds for cancellation of the group's certificate of approval.

SECTION 6. This Act applies only to an insurance policy or contract delivered, issued for delivery, or renewed on or after January 1, 2008. A policy or contract delivered, issued for delivery, or renewed before January 1, 2008, is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose.

SECTION 7. This Act takes effect September 1, 2007.