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A BILL TO BE ENTITLED
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AN ACT
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relating to preauthorization of certain medical services in the |
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workers' compensation system and the eligibility of doctors, |
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dentists, and chiropractors to perform preauthorization |
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utilization review. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1305.351, Insurance Code, is amended by |
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adding Subsection (e) to read as follows: |
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(e) If a network or insurance carrier uses a |
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preauthorization process within the network, not later than the |
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30th day after the date of making a decision regarding a request for |
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preauthorization, the network or carrier shall submit to the |
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division of workers' compensation of the department: |
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(1) a statement of: |
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(A) whether the network or carrier approved, |
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approved in part, or denied the request for preauthorization; and |
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(B) the reason the network or carrier made the |
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decision under Paragraph (A); and |
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(2) any relevant supporting material, including any |
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reports by medical professionals who reviewed the case. |
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SECTION 2. Section 408.0043, Labor Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A doctor who performs preauthorization utilization |
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review for an insurance network or carrier must: |
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(1) maintain the doctor's primary practice location in |
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this state; and |
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(2) earn at least 50 percent of the doctor's annual |
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income from the practice of treating patients. |
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SECTION 3. Section 408.0044, Labor Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A dentist who performs preauthorization utilization |
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review for an insurance network or carrier must: |
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(1) maintain the dentist's primary practice location |
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in this state; and |
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(2) earn at least 50 percent of the dentist's annual |
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income from the practice of treating patients. |
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SECTION 4. Section 408.0045, Labor Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A chiropractor who performs preauthorization |
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utilization review for an insurance network or carrier must: |
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(1) maintain the chiropractor's primary practice |
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location in this state; and |
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(2) earn at least 50 percent of the chiropractor's |
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annual income from the practice of treating patients. |
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SECTION 5. Section 413.014, Labor Code, is amended by |
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adding Subsection (g) to read as follows: |
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(g) Not later than the 30th day after the date of making a |
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decision regarding a request for preauthorization, the insurance |
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carrier shall submit to the division: |
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(1) a statement of: |
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(A) whether the carrier approved, approved in |
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part, or denied the request for preauthorization; and |
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(B) the reason the carrier made the decision |
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under Paragraph (A); and |
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(2) any relevant supporting material, including any |
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reports by medical professionals who reviewed the case. |
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SECTION 6. The change in law made by this Act applies to a |
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preauthorization request in connection with a claim for workers' |
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compensation benefits that is made on or after the effective date of |
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this Act. A preauthorization request that was made before that date |
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is governed by the law in effect when the request was made, and the |
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former law is continued in effect for that purpose. |
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SECTION 7. This Act takes effect September 1, 2011. |