BILL ANALYSIS

H.B. 287

By: Zedler

Insurance

Committee Report (Unamended)

BACKGROUND AND PURPOSE

Current law establishes the confidentiality of information that reveals the identity of a physician or other individual health care provider who makes a review determination for an independent review organization regarding a claim for health care services under a health insurance policy or a health benefit plan or under the Workers' Compensation Health Care Network Act. Interested parties assert that the lack of transparency regarding such information enhances the possibility that expert witnesses used in the review may be advising on subjects that are not within the scope of their profession and enhances the possibility of witness conflicts of interest.  H.B. 287 seeks to remedy this situation by entitling certain parties to obtain the name and professional qualifications of a physician or other health care provider who makes a review determination. 

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

H.B. 287 amends the Insurance Code to create an exception to provisions that establish the confidentiality of information that reveals the identity of a physician or other health care provider who makes a review determination for an independent review organization of a claim for health care services under a health insurance policy or a health benefit plan or under the Workers' Compensation Health Care Network Act by entitling a party to a reviewed medical dispute or a party that sought the independent review of an adverse determination, as applicable, to the name and professional qualifications of any doctor or other health care practitioner used to perform the review following the completion of the review and on written request to the utilization review agent or independent review organization.

EFFECTIVE DATE

September 1, 2013.