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A BILL TO BE ENTITLED
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AN ACT
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relating to requiring that a doctor who reviews a workers' |
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compensation case be certified in a professional specialty |
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appropriate to the care received by the injured employee. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 408, Labor Code, is |
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amended by adding Sections 408.0043 through 408.0046 to read as |
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follows: |
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Sec. 408.0043. PROFESSIONAL SPECIALTY CERTIFICATION |
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REQUIRED FOR CERTAIN REVIEW. (a) This section applies to a person, |
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other than a chiropractor or a dentist, who performs health care |
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services under this title as: |
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(1) a doctor performing peer review; |
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(2) a doctor performing a utilization review of a |
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health care service provided to an injured employee, including a |
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retrospective review; |
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(3) a doctor performing an independent review of a |
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health care service provided to an injured employee, including a |
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retrospective review; |
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(4) a designated doctor; |
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(5) a doctor performing a required medical |
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examination; or |
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(6) a doctor serving as a member of the medical quality |
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review panel. |
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(b) A person described by Subsection (a) who reviews a |
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specific workers' compensation case must hold a professional |
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certification in a health care specialty appropriate to the type of |
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health care that the injured employee is receiving. |
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Sec. 408.0044. REVIEW OF DENTAL SERVICES. (a) This section |
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applies to a dentist who performs dental services under this title |
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as: |
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(1) a doctor performing peer review of dental |
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services; |
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(2) a doctor performing a utilization review of a |
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dental service provided to an injured employee, including a |
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retrospective review; |
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(3) a doctor performing an independent review of a |
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dental service provided to an injured employee, including a |
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retrospective review; or |
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(4) a doctor performing a required dental examination. |
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(b) A person described by Subsection (a) who reviews a |
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dental service provided in conjunction with a specific workers' |
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compensation case must be licensed to practice dentistry. |
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Sec. 408.0045. REVIEW OF CHIROPRACTIC SERVICES. (a) This |
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section applies to a person who performs services under this title |
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as: |
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(1) a doctor performing peer review of chiropractic |
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services; |
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(2) a doctor performing a utilization review of a |
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chiropractic service provided to an injured employee, including a |
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retrospective review; |
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(3) a doctor performing an independent review of a |
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chiropractic service provided to an injured employee, including a |
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retrospective review; |
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(4) a designated doctor providing chiropractic |
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services; |
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(5) a doctor performing a required medical |
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examination; or |
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(6) a chiropractor serving as a member of the medical |
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quality review panel. |
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(b) A person described by Subsection (a) who reviews a |
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chiropractic service provided in conjunction with a specific |
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workers' compensation case must be licensed to engage in the |
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practice of chiropractic or must be a physician licensed to engage |
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in the practice of medicine who is certified in an appropriate |
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medical specialty. |
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Sec. 408.0046. RULES. The commissioner may adopt rules as |
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necessary to determine which professional health practitioner |
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specialties are appropriate for treatment of certain compensable |
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injuries. |
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SECTION 2. Section 408.004, Labor Code, is amended by |
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adding Subsection (a-1) to read as follows: |
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(a-1) A doctor, other than a chiropractor, who performs a |
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required medical examination under this section is subject to |
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Section 408.0043. A chiropractor who performs a required medical |
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examination under this section is subject to Section 408.0045. |
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SECTION 3. Section 408.0041(b), Labor Code, is amended to |
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read as follows: |
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(b) A medical examination requested under Subsection (a) |
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shall be performed by the next available doctor on the division's |
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list of designated doctors whose credentials are appropriate for |
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the issue in question and the injured employee's medical condition |
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as determined by commissioner rule. A designated doctor, other than |
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a chiropractor, is subject to Section 408.0043. A designated |
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doctor who is a chiropractor is subject to Section 408.0045. The |
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division shall assign a designated doctor not later than the 10th |
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day after the date on which the request under Subsection (a) is |
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approved, and the examination must be conducted not later than the |
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21st day after the date on which the commissioner issues the order |
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under Subsection (a). An examination under this section may not be |
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conducted more frequently than every 60 days, unless good cause for |
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more frequent examinations exists, as defined by commissioner |
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rules. |
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SECTION 4. Section 408.0231(g), Labor Code, is amended to |
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read as follows: |
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(g) The commissioner shall adopt rules regarding doctors |
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who perform peer review functions for insurance carriers. Those |
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rules may include standards for peer review, imposition of |
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sanctions on doctors performing peer review functions, including |
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restriction, suspension, or removal of the doctor's ability to |
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perform peer review on behalf of insurance carriers in the workers' |
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compensation system, and other issues important to the quality of |
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peer review, as determined by the commissioner. A doctor who |
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performs peer review under this subtitle must hold the appropriate |
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professional license issued by this state. A doctor, other than a |
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chiropractor or a dentist, who performs peer review is subject to |
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Section 408.0043. A dentist who performs a peer review of a dental |
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service provided to an injured employee is subject to Section |
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408.0044. A chiropractor who performs a peer review of a |
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chiropractic service provided to an injured employee is subject to |
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Section 408.0045. |
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SECTION 5. Section 408.1225, Labor Code, is amended by |
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adding Subsection (e) to read as follows: |
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(e) A designated doctor, other than a chiropractor, is |
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subject to Section 408.0043. A designated doctor who is a |
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chiropractor is subject to Section 408.0045. |
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SECTION 6. Section 413.031, Labor Code, is amended by |
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amending Subsections (d) and (e) and adding Subsection (e-3) 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-3) Notwithstanding Subsections (d) and (e) of this |
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section or Chapters 4201 and 4202, Insurance Code, a doctor, other |
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than a dentist or a chiropractor, who performs a utilization review |
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or an independent review, including a retrospective review, of a |
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health care service provided to an injured employee is subject to |
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Section 408.0043. A dentist who performs a utilization review or an |
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independent review, including a retrospective review, of a dental |
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service provided to an injured employee is subject to Section |
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408.0044. A chiropractor who performs a utilization review or an |
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independent review, including a retrospective review, of a |
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chiropractic service provided to an injured employee is subject to |
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Section 408.0045. |
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SECTION 7. Section 413.0512, Labor Code, is amended by |
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adding Subsection (f) to read as follows: |
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(f) A member of the medical quality review panel, other than |
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a chiropractor, who reviews a specific workers' compensation case |
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is subject to Section 408.0043. A chiropractor who reviews a |
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specific workers' compensation case is subject to Section 408.0045. |
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SECTION 8. The change in law made by this Act applies only |
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to a review of a health care service provided under a claim for |
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workers' compensation benefits that is conducted on or after the |
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effective date of this Act. A review that is conducted before that |
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date is governed by the law in effect on the date that the review was |
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conducted, and the former law is continued in effect for that |
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purpose. |
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SECTION 9. This Act takes effect September 1, 2007. |
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* * * * * |