BILL ANALYSIS H.B. 3625 By: Elkins Business & Industry Committee Report (Unamended) BACKGROUND AND PURPOSE Both medical providers and utilization review agents may address treatment associated with an injured worker whose injuries are handled inside a worker's compensation healthcare network (in-network) and whose injuries are handled outside a workers' compensation healthcare network (non-network). Currently, in-network responsiveness is measured in calendar days rather than working days, so there are different regulatory response times for utilization review agents and medical providers. This inconsistency is a source of confusion and conflict. In addition, the use of calendar days can create difficulty in obtaining additional information or facilitating peer-to-peer discussions when a request is received at the end of a business week. H.B. 3625 conforms in-network language to non-network language by requiring a utilization review agent to issue and transmit a determination regarding the preauthorization of proposed health care services under a workers' compensation claim by not later than the third working day, rather than calendar day, after the date a preauthorization request is received from a provider. 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. 3625 amends the Insurance Code to specify that a determination from a utilization review agent to indicate whether proposed health care services under a workers' compensation claim are preauthorized must be issued and transmitted not later than the third working day, rather than the third calendar day, after the date a preauthorization request from a provider for proposed services is received. The bill defines "working day" for these purposes as having the meaning under provisions governing utilization review agents. EFFECTIVE DATE September 1, 2009.
BILL ANALYSIS
# BILL ANALYSIS
H.B. 3625
By: Elkins
Business & Industry
Committee Report (Unamended)
H.B. 3625
By: Elkins
Business & Industry
Committee Report (Unamended)
BACKGROUND AND PURPOSE Both medical providers and utilization review agents may address treatment associated with an injured worker whose injuries are handled inside a worker's compensation healthcare network (in-network) and whose injuries are handled outside a workers' compensation healthcare network (non-network). Currently, in-network responsiveness is measured in calendar days rather than working days, so there are different regulatory response times for utilization review agents and medical providers. This inconsistency is a source of confusion and conflict. In addition, the use of calendar days can create difficulty in obtaining additional information or facilitating peer-to-peer discussions when a request is received at the end of a business week. H.B. 3625 conforms in-network language to non-network language by requiring a utilization review agent to issue and transmit a determination regarding the preauthorization of proposed health care services under a workers' compensation claim by not later than the third working day, rather than calendar day, after the date a preauthorization request is received from a provider.
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. 3625 amends the Insurance Code to specify that a determination from a utilization review agent to indicate whether proposed health care services under a workers' compensation claim are preauthorized must be issued and transmitted not later than the third working day, rather than the third calendar day, after the date a preauthorization request from a provider for proposed services is received. The bill defines "working day" for these purposes as having the meaning under provisions governing utilization review agents.
EFFECTIVE DATE September 1, 2009.
BACKGROUND AND PURPOSE
Both medical providers and utilization review agents may address treatment associated with an injured worker whose injuries are handled inside a worker's compensation healthcare network (in-network) and whose injuries are handled outside a workers' compensation healthcare network (non-network). Currently, in-network responsiveness is measured in calendar days rather than working days, so there are different regulatory response times for utilization review agents and medical providers. This inconsistency is a source of confusion and conflict. In addition, the use of calendar days can create difficulty in obtaining additional information or facilitating peer-to-peer discussions when a request is received at the end of a business week.
H.B. 3625 conforms in-network language to non-network language by requiring a utilization review agent to issue and transmit a determination regarding the preauthorization of proposed health care services under a workers' compensation claim by not later than the third working day, rather than calendar day, after the date a preauthorization request is received from a provider.
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. 3625 amends the Insurance Code to specify that a determination from a utilization review agent to indicate whether proposed health care services under a workers' compensation claim are preauthorized must be issued and transmitted not later than the third working day, rather than the third calendar day, after the date a preauthorization request from a provider for proposed services is received. The bill defines "working day" for these purposes as having the meaning under provisions governing utilization review agents.
EFFECTIVE DATE
September 1, 2009.