Texas 2009 - 81st Regular

Texas House Bill HB3822 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R5675 KCR-F
2	2	By: Leibowitz H.B. No. 3822
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to review of the medical necessity of certain health care
8	8	provided in connection with a workers' compensation claim.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 413, Labor Code, is
11	11	amended by adding Section 413.0142 to read as follows:
12	12	Sec. 413.0142. WAIVER OF CERTAIN INSURER CHALLENGES. (a)
13	13	Regarding a specific treatment or service approved in the
14	14	preauthorization process, an insurance carrier waives the right to
15	15	raise a future challenge alleging that an injury sustained by an
16	16	injured employee is not compensable or that health care provided to
17	17	an injured employee was not related to a compensable injury if:
18	18	(1) the insurance carrier does not include the
19	19	compensability of the injury or that the health care provided to the
20	20	injured employee was not related to a compensable injury as a basis
21	21	for an initial denial of a request for preauthorization or the
22	22	denial of reconsideration of coverage; and
23	23	(2) the requested treatment or service is ultimately
24	24	determined through a medical dispute resolution proceeding to be
25	25	health care reasonably required under this subtitle.
26	26	(b) This section may not be construed as limiting an
27	27	insurance carrier's ability to challenge compensability or the
28	28	relatedness to a compensable injury of provided health care if the
29	29	challenge concerns income benefits or medical benefits not included
30	30	in the preauthorization request.
31	31	(c) If the insurance carrier raises a compensability or
32	32	relatedness issue in a denial of preauthorization, that issue must
33	33	be considered and resolved in the same proceeding that addresses
34	34	the issue of whether the requested treatment or service is health
35	35	care reasonably required under this subtitle.
36	36	SECTION 2. Section 413.031(d), Labor Code, is amended to
37	37	read as follows:
38	38	(d) A review of the medical necessity of a health care
39	39	service requiring preauthorization under Section 413.014 or
40	40	commissioner rules under that section or Section 413.011(g) shall
41	41	be conducted by an independent review organization under Chapter
42	42	4202, Insurance Code, in the same manner as reviews of utilization
43	43	review decisions by health maintenance organizations. The
44	44	independent review organization's decision is limited to whether
45	45	the proposed treatment or service is health care reasonably
46	46	required for the injury. The independent review organization may
47	47	not consider issues relating to allegations as to whether the
48	48	injury in question is compensable or that the health care provided
49	49	to the injured employee was not related to the compensable injury.
50	50	It is a defense for the insurance carrier if the carrier timely
51	51	complies with the decision of the independent review organization.
52	52	SECTION 3. The change in law made by this Act applies only
53	53	to a claim for workers' compensation benefits based on a
54	54	compensable injury that occurs on or after the effective date of
55	55	this Act. A claim based on a compensable injury that occurs before
56	56	that date is governed by the law in effect on the date the
57	57	compensable injury occurred, and the former law is continued in
58	58	effect for that purpose.
59	59	SECTION 4. This Act takes effect September 1, 2009.