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A BILL TO BE ENTITLED
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AN ACT
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relating to benefit review conferences and certain required reports |
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under the Texas workers' compensation system. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1305.502(a), Insurance Code, is amended |
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to read as follows: |
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(a) Not later than December 1 of each even-numbered year, |
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the [The] group shall develop and issue an [annual] informational |
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report card that identifies and compares, on an objective basis, |
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the quality, costs, health care provider availability, and other |
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analogous factors of workers' compensation health care networks |
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operating under the workers' compensation system of this state with |
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each other and with medical care provided outside of networks. |
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SECTION 2. The heading to Section 410.005, Labor Code, is |
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amended to read as follows: |
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Sec. 410.005. CONDUCTING [VENUE FOR] ADMINISTRATIVE |
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PROCEEDINGS. |
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SECTION 3. Section 410.005, Labor Code, is amended by |
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amending Subsections (a) and (d) and adding Subsection (e) to read |
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as follows: |
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(a) Unless the division determines that good cause exists |
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for the selection of a different location, [a benefit review |
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conference or] a contested case hearing may not be conducted at a |
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site more than 75 miles from the claimant's residence at the time of |
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the injury. |
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(d) The [Notwithstanding Subsection (a), the] division may |
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conduct a benefit review conference: |
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(1) telephonically; |
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(2) by videoconference; or |
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(3) in person, on showing of good cause as determined |
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by the division [on agreement by the injured employee]. |
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(e) Unless the division determines that good cause exists |
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for the selection of a different location, a benefit review |
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conference conducted in person under Subsection (d)(3) may not be |
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conducted at a site more than 75 miles from the claimant's residence |
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at the time of the injury. |
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SECTION 4. Sections 504.053(c) and (d), Labor Code, are |
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amended to read as follows: |
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(c) If the political subdivision or pool provides medical |
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benefits in the manner authorized under Subsection (b)(2), the |
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following do not apply: |
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(1) Sections 408.004 and 408.0041, unless use of a |
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required medical examination or designated doctor is necessary to |
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resolve an issue relating to the entitlement to or amount of income |
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benefits under this title; |
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(2) Subchapter B, Chapter 408, except for Section |
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408.021; |
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(3) Chapter 413, except for Section 413.042; and |
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(4) Chapter 1305, Insurance Code, except for Sections |
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[1305.501,] 1305.502[,] and 1305.503. |
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(d) If the political subdivision or pool provides medical |
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benefits in the manner authorized under Subsection (b)(2), the |
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following standards apply: |
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(1) the political subdivision or pool must ensure that |
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workers' compensation medical benefits are reasonably available to |
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all injured workers of the political subdivision or the injured |
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workers of the members of the pool within a designed service area; |
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(2) the political subdivision or pool must ensure that |
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all necessary health care services are provided in a manner that |
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will ensure the availability of and accessibility to adequate |
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health care providers, specialty care, and facilities; |
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(3) the political subdivision or pool must have an |
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internal review process for resolving complaints relating to the |
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manner of providing medical benefits, including an appeal to the |
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governing body or its designee and appeal to an independent review |
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organization; |
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(4) the political subdivision or pool must establish |
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reasonable procedures for the transition of injured workers to |
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contract providers and for the continuity of treatment, including |
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notice of impending termination of providers and a current list of |
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contract providers; |
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(5) the political subdivision or pool shall provide |
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for emergency care if an injured worker cannot reasonably reach a |
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contract provider and the care is for medical screening or other |
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evaluation that is necessary to determine whether a medical |
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emergency condition exists, necessary emergency care services |
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including treatment and stabilization, and services originating in |
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a hospital emergency facility following treatment or stabilization |
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of an emergency medical condition; |
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(6) prospective or concurrent review of the medical |
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necessity and appropriateness of health care services must comply |
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with Article 21.58A, Insurance Code; |
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(7) the political subdivision or pool shall continue |
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to report data to the appropriate agency as required by Title 5 of |
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this code and Chapter 1305, Insurance Code; and |
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(8) a political subdivision or pool is subject to the |
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requirements under Sections [1305.501,] 1305.502[,] and 1305.503, |
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Insurance Code. |
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SECTION 5. The following provisions are repealed: |
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(1) Section 1305.501, Insurance Code; |
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(2) Section 2053.012, Insurance Code; and |
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(3) Sections 405.0025(b) and (c), Labor Code. |
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SECTION 6. Section 410.005, Labor Code, as amended by this |
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Act, applies to a benefit review conference requested on or after |
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the effective date of this Act. A benefit review conference |
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requested before the effective date of this Act is governed by the |
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law in effect on the date the benefit review conference was |
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requested, and the former law is continued in effect for that |
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purpose. |
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SECTION 7. 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, 2021. |