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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of and payment for certain health care |
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services provided through workers' compensation health care |
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networks to fire protection personnel. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1305.006, Insurance Code, is amended to |
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read as follows: |
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Sec. 1305.006. INSURANCE CARRIER LIABILITY FOR NON-NETWORK |
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OR OUT-OF-NETWORK HEALTH CARE. (a) An insurance carrier that |
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establishes or contracts with a network is liable for the following |
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out-of-network health care that is provided to an injured employee: |
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(1) emergency care; |
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(2) health care provided to an injured employee who |
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does not live within the service area of any network established by |
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the insurance carrier or with which the insurance carrier has a |
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contract; and |
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(3) health care provided by an out-of-network provider |
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pursuant to a referral from the injured employee's treating doctor |
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that has been approved by the network pursuant to Section 1305.103. |
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(b) An insurance carrier that establishes or contracts with |
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a network is liable for out-of-network health care or non-network |
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health care that is provided to an injured employee who is diagnosed |
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with cancer related to work performed by the employee as fire |
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protection personnel, as defined by Section 419.021, Government |
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Code, regardless of whether the health care services are provided |
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in the manner described by Subsection (a)(3). |
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SECTION 2. Section 1305.101(a), Insurance Code, is amended |
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to read as follows: |
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(a) Except for emergencies and out-of-network referrals and |
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subject to Section 1305.006(b), a network shall provide or arrange |
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for health care services only through providers or provider groups |
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that are under contract with or are employed by the network. |
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SECTION 3. Section 408.027(f), Labor Code, is amended to |
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read as follows: |
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(f) Any payment made by an insurance carrier under this |
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section shall be made: |
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(1) in accordance with the fee guidelines authorized |
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under this subtitle if the health care service is not provided |
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through a workers' compensation health care network under Chapter |
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1305, Insurance Code, including an out-of-network or non-network |
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health care service provided to an injured employee in accordance |
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with Section 1305.006(b), Insurance Code; or |
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(2) at a contracted rate for that health care service |
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if the health care service is provided through a workers' |
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compensation health care network under Chapter 1305, Insurance |
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Code. |
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SECTION 4. The changes in law made by this Act apply only to |
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health care services provided on or after the effective date of this |
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Act in conjunction with a claim for workers' compensation benefits, |
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regardless of the date on which the compensable injury that is the |
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basis of the claim occurred. |
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SECTION 5. This Act takes effect September 1, 2011. |