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A BILL TO BE ENTITLED
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AN ACT
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relating to a demonstration program at the State Office of Risk |
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Management for real-time processing of workers' compensation |
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authorizations of payment for medical services and medical bills. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 412, Labor Code, is |
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amended by adding Section 412.0129 to read as follows: |
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Sec. 412.0129. AUTHORIZATION OF PAYMENT FOR MEDICAL |
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SERVICES AND MEDICAL BILLS REAL-TIME PROCESSING DEMONSTRATION |
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PROGRAM. (a) The office may develop and implement a demonstration |
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program for processing workers' compensation authorizations of |
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payment for medical services and medical bills in real time if the |
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office determines that the program would be cost-effective. |
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(b) The demonstration program described by Subsection (a) |
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must include: |
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(1) a secure single platform, Internet-based portal |
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for use by the office, state agencies, injured employees, and |
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health care providers; |
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(2) the ability to collect, input, and transmit |
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administrative and clinical data, including: |
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(A) patient information; |
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(B) provider contracts; |
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(C) treatment guidelines; and |
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(D) other information the office considers |
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necessary for processing authorizations and medical bills; |
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(3) an automated process to streamline requests for |
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authorizations of payment for medical services and peer reviews at |
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the point of care; and |
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(4) return-to-work best practices for workers' |
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compensation claims, including complex case management. |
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(c) The workers' compensation research and evaluation group |
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may assist the office in identifying and adopting measures for |
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evaluating the demonstration program. |
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(d) The evaluation period for the demonstration program |
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shall end on June 30, 2022. |
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(e) If the office implements a demonstration program under |
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this section, not later than December 31, 2022, the office shall |
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provide to the board a report that: |
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(1) evaluates the program, including any effects of |
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the program on administrative cost savings; and |
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(2) recommends whether to use the process implemented |
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under the program on a permanent basis. |
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(f) If the report of the demonstration program under |
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Subsection (e) indicates that administrative cost savings are |
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achieved by the process implemented under the program, the board |
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may adopt and use the process on a permanent basis. |
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(g) If the report of the demonstration program under |
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Subsection (e) indicates that administrative cost savings were not |
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achieved by the process implemented under the program, not later |
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than December 31, 2022, the office shall submit to the legislature a |
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written report that contains: |
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(1) the reasons that the program did not result in |
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administrative cost savings; and |
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(2) recommendations for proposed legislation to |
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develop a cost-effective system for processing workers' |
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compensation authorizations of payment for medical services and |
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medical bills in real time. |
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(h) This section expires September 1, 2023. |
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SECTION 2. Not later than January 1, 2020, the State Office |
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of Risk Management shall study and make a determination as to |
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whether the demonstration program described by Section 412.0129, |
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Labor Code, as added by this Act, would be cost-effective. If the |
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office determines the program would be cost-effective and decides |
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to implement the program, the office shall fully implement the |
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program not later than January 1, 2021. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2019. |