86R29669 KKR-D
 
  By: Shine, Darby, Parker H.B. No. 2919
 
  Substitute the following for H.B. No. 2919:
 
  By:  Darby C.S.H.B. No. 2919
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
 
  relating to a demonstration program at the State Office of Risk
  Management for real-time processing of workers' compensation
  authorizations of payment for medical services and medical bills.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 412, Labor Code, is
  amended by adding Section 412.0129 to read as follows:
         Sec. 412.0129.  AUTHORIZATION OF PAYMENT FOR MEDICAL
  SERVICES AND MEDICAL BILLS REAL-TIME PROCESSING DEMONSTRATION
  PROGRAM. (a)  The office may develop and implement a demonstration
  program for processing workers' compensation authorizations of
  payment for medical services and medical bills in real time if the
  office determines that the program would be cost-effective.
         (b)  The demonstration program described by Subsection (a)
  must include:
               (1)  a secure single platform, Internet-based portal
  for use by the office, state agencies, injured employees, and
  health care providers;
               (2)  the ability to collect, input, and transmit
  administrative and clinical data, including:
                     (A)  patient information;
                     (B)  provider contracts;
                     (C)  treatment guidelines; and
                     (D)  other information the office considers
  necessary for processing authorizations and medical bills;
               (3)  an automated process to streamline requests for
  authorizations of payment for medical services and peer reviews at
  the point of care; and
               (4)  return-to-work best practices for workers'
  compensation claims, including complex case management.
         (c)  The workers' compensation research and evaluation group
  may assist the office in identifying and adopting measures for
  evaluating the demonstration program.
         (d)  The evaluation period for the demonstration program
  shall end on June 30, 2022.
         (e)  If the office implements a demonstration program under
  this section, not later than December 31, 2022, the office shall
  provide to the board a report that:
               (1)  evaluates the program, including any effects of
  the program on administrative cost savings; and
               (2)  recommends whether to use the process implemented
  under the program on a permanent basis.
         (f)  If the report of the demonstration program under
  Subsection (e) indicates that administrative cost savings are
  achieved by the process implemented under the program, the board
  may adopt and use the process on a permanent basis.
         (g)  If the report of the demonstration program under
  Subsection (e) indicates that administrative cost savings were not
  achieved by the process implemented under the program, not later
  than December 31, 2022, the office shall submit to the legislature a
  written report that contains:
               (1)  the reasons that the program did not result in
  administrative cost savings; and
               (2)  recommendations for proposed legislation to
  develop a cost-effective system for processing workers'
  compensation authorizations of payment for medical services and
  medical bills in real time.
         (h)  This section expires September 1, 2023.
         SECTION 2.  Not later than January 1, 2020, the State Office
  of Risk Management shall study and make a determination as to
  whether the demonstration program described by Section 412.0129,
  Labor Code, as added by this Act, would be cost-effective. If the
  office determines the program would be cost-effective and decides
  to implement the program, the office shall fully implement the
  program not later than January 1, 2021.
         SECTION 3.  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, 2019.