BILL ANALYSIS

H.B. 3625

By: Elkins

Business & Industry

Committee Report (Unamended)

BACKGROUND AND PURPOSE

Both medical providers and utilization review agents may address treatment associated with an injured worker whose injuries are handled inside a worker's compensation healthcare network (in-network) and whose injuries are handled outside a workers' compensation healthcare network (non-network).  Currently, in-network responsiveness is measured in calendar days rather than working days, so there are different regulatory response times for utilization review agents and medical providers.  This inconsistency is a source of confusion and conflict.  In addition, the use of calendar days can create difficulty in obtaining additional information or facilitating peer-to-peer discussions when a request is received at the end of a business week. 

H.B. 3625 conforms in-network language to non-network language by requiring a utilization review agent to issue and transmit a determination regarding the preauthorization of proposed health care services under a workers' compensation claim by not later than the third working day, rather than calendar day, after the date a preauthorization request is received from a provider.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

H.B. 3625 amends the Insurance Code to specify that a determination from a utilization review agent to indicate whether proposed health care services under a workers' compensation claim are preauthorized must be issued and transmitted not later than the third working day, rather than the third calendar day, after the date a preauthorization request from a provider for proposed services is received. The bill defines "working day" for these purposes as having the meaning under provisions governing utilization review agents.

EFFECTIVE DATE

September 1, 2009.