82R10744 JSC-F

By: Madden H.B. No. 2634

A BILL TO BE ENTITLED

AN ACT

relating to extending workers' compensation benefits for certain state employees.

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

SECTION 1. Subchapter C, Chapter 501, Labor Code, is amended by adding Section 501.0451 to read as follows:

Sec. 501.0451. ELECTION. (a) The office may elect to provide workers' compensation medical benefits to employees through a health care network certified under Chapter 1305, Insurance Code, if the office determines that provision of those benefits through a network is:

(1) available to the employees; and

(2) practical for the state.

(b) If the office determines that a workers' compensation health care network certified under Chapter 1305, Insurance Code, is not available or practical for the state, the office may provide medical benefits to employees:

(1) in the manner provided by Chapter 408, other than Sections 408.001(b) and (c) and 408.002, and by Subchapters B and C, Chapter 413; or

(2) by contracting with health care providers in a manner consistent with this section.

(c) If the office provides medical benefits in the manner authorized by Subsection (b)(2), the following provisions do not apply:

(1) Sections 408.001 and 408.0041, unless use of a required medical examination or designated doctor is necessary to resolve an issue relating to the entitlement to or amount of income benefits under this title;

(2) Subchapter B, Chapter 408, except for Section 408.021;

(3) Chapter 413, except for Section 413.042; and

(4) Chapter 1305, Insurance Code, except for Subchapter K.

(d) If the office provides medical benefits in the manner authorized by Subsection (b)(2), the following standards apply:

(1) the office must ensure that workers' compensation medical benefits are reasonably available to all covered employees within a service area;

(2) the office must ensure that all necessary health care services are provided in a manner that will ensure the availability of and accessibility to adequate health care providers, specialty care, and facilities;

(3) the office must have an internal review process for resolving complaints relating to the manner of providing medical benefits, including an appeal to the governing body or its designee and an appeal to an independent review organization;

(4) the office must establish reasonable procedures for the transition of injured workers to contract providers and for the continuity of treatment, including notice of impending termination of providers and a current list of contract providers;

(5) the office shall provide for emergency care if an injured worker cannot reasonably reach a contract provider and the care is for:

(A) a medical screening or other evaluation that is necessary to determine whether a medical emergency condition exists;

(B) necessary emergency care services, including treatment and stabilization; or

(C) services originating in a hospital emergency facility following treatment or stabilization of an emergency medical condition;

(6) prospective or concurrent review of the medical necessity and appropriateness of health care services must comply with Chapter 4201, Insurance Code;

(7) the office shall continue to report data to the appropriate agency as required by this title and Chapter 1305, Insurance Code; and

(8) the office is subject to the requirements of Subchapter K, Chapter 1305, Insurance Code.

(e) The office has exclusive authority to provide health care services under this chapter to employees:

(1) in the manner authorized by this section; or

(2) by contracting with networks under Chapter 1305, Insurance Code.

(f) This chapter does not waive sovereign immunity or create a new cause of action.

SECTION 2. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2011.