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A BILL TO BE ENTITLED
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AN ACT
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relating to workers' compensation health care reimbursement |
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policies and fee guidelines for certain health care services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 413.011(a) and (d), Labor Code, are |
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amended to read as follows: |
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(a) The commissioner shall adopt health care reimbursement |
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policies and guidelines that reflect the standardized |
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reimbursement structures found in other health care delivery |
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systems and may modify [with minimal modifications to] those |
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reimbursement methodologies as necessary to meet occupational |
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injury requirements. To achieve standardization, the commissioner |
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shall consider [adopt] the most current reimbursement |
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methodologies, models, and values or weights used by the federal |
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Centers for Medicare and Medicaid Services, including applicable |
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payment policies relating to coding, billing, and reporting, and |
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may modify documentation requirements as necessary to meet the |
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requirements of Section 413.053. |
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(d) Fee guidelines must be fair and reasonable and designed |
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to ensure the quality of medical care and to achieve effective |
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medical cost control. The guidelines may not provide for payment |
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of a fee in excess of the fee charged for similar treatment of an |
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injured individual of an equivalent standard of living and paid by |
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that individual or by someone acting on that individual's behalf. |
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The guidelines may not provide for payment of a fee for a procedure |
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performed in an ambulatory surgical center that is different from |
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the fee for the same procedure performed in a hospital outpatient |
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department or other outpatient setting. The commissioner shall |
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consider the increased security of payment afforded by this |
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subtitle in establishing the fee guidelines. |
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SECTION 2. This Act takes effect September 1, 2009. |