82R8683 JSC-D

By: Zedler H.B. No. 3429

A BILL TO BE ENTITLED

AN ACT

relating to preauthorization of certain medical services in the workers' compensation system and the eligibility of doctors, dentists, and chiropractors to perform preauthorization utilization review.

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

SECTION 1. Section 1305.351, Insurance Code, is amended by adding Subsection (e) to read as follows:

(e) If a network or insurance carrier uses a preauthorization process within the network, not later than the 30th day after the date of making a decision regarding a request for preauthorization, the network or carrier shall submit to the division of workers' compensation of the department:

(1) a statement of:

(A) whether the network or carrier approved, approved in part, or denied the request for preauthorization; and

(B) the reason the network or carrier made the decision under Paragraph (A); and

(2) any relevant supporting material, including any reports by medical professionals who reviewed the case.

SECTION 2. Section 408.0043, Labor Code, is amended by adding Subsection (c) to read as follows:

(c) A doctor who performs preauthorization utilization review for an insurance network or carrier must:

(1) maintain the doctor's primary practice location in this state; and

(2) earn at least 50 percent of the doctor's annual income from the practice of treating patients.

SECTION 3. Section 408.0044, Labor Code, is amended by adding Subsection (c) to read as follows:

(c) A dentist who performs preauthorization utilization review for an insurance network or carrier must:

(1) maintain the dentist's primary practice location in this state; and

(2) earn at least 50 percent of the dentist's annual income from the practice of treating patients.

SECTION 4. Section 408.0045, Labor Code, is amended by adding Subsection (c) to read as follows:

(c) A chiropractor who performs preauthorization utilization review for an insurance network or carrier must:

(1) maintain the chiropractor's primary practice location in this state; and

(2) earn at least 50 percent of the chiropractor's annual income from the practice of treating patients.

SECTION 5. Section 413.014, Labor Code, is amended by adding Subsection (g) to read as follows:

(g) Not later than the 30th day after the date of making a decision regarding a request for preauthorization, the insurance carrier shall submit to the division:

(1) a statement of:

(A) whether the carrier approved, approved in part, or denied the request for preauthorization; and

(B) the reason the carrier made the decision under Paragraph (A); and

(2) any relevant supporting material, including any reports by medical professionals who reviewed the case.

SECTION 6. The change in law made by this Act applies to a preauthorization request in connection with a claim for workers' compensation benefits that is made on or after the effective date of this Act. A preauthorization request that was made before that date is governed by the law in effect when the request was made, and the former law is continued in effect for that purpose.

SECTION 7. This Act takes effect September 1, 2011.