| 1 | 1 | | 81R14063 ALB-F |
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| 2 | 2 | | By: Uresti S.B. No. 1985 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to workers' compensation health care reimbursement |
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| 8 | 8 | | policies and fee guidelines for certain health care services. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Sections 413.011(a) and (d), Labor Code, are |
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| 11 | 11 | | amended to read as follows: |
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| 12 | 12 | | (a) The commissioner shall adopt health care reimbursement |
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| 13 | 13 | | policies and guidelines that reflect the standardized |
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| 14 | 14 | | reimbursement structures found in other health care delivery |
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| 15 | 15 | | systems and may modify [with minimal modifications to] those |
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| 16 | 16 | | reimbursement methodologies as necessary to meet occupational |
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| 17 | 17 | | injury requirements. To achieve standardization, the commissioner |
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| 18 | 18 | | shall consider [adopt] the most current reimbursement |
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| 19 | 19 | | methodologies, models, and values or weights used by the federal |
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| 20 | 20 | | Centers for Medicare and Medicaid Services, including applicable |
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| 21 | 21 | | payment policies relating to coding, billing, and reporting, and |
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| 22 | 22 | | may modify documentation requirements as necessary to meet the |
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| 23 | 23 | | requirements of Section 413.053. |
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| 24 | 24 | | (d) Fee guidelines must be fair and reasonable and designed |
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| 25 | 25 | | to ensure the quality of medical care and to achieve effective |
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| 26 | 26 | | medical cost control. The guidelines may not provide for payment |
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| 27 | 27 | | of a fee in excess of the fee charged for similar treatment of an |
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| 28 | 28 | | injured individual of an equivalent standard of living and paid by |
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| 29 | 29 | | that individual or by someone acting on that individual's behalf. |
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| 30 | 30 | | The guidelines may not provide for payment of a fee for a procedure |
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| 31 | 31 | | performed in an ambulatory surgical center that is different from |
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| 32 | 32 | | the fee for the same procedure performed in a hospital outpatient |
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| 33 | 33 | | department or other outpatient setting. The commissioner shall |
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| 34 | 34 | | consider the increased security of payment afforded by this |
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| 35 | 35 | | subtitle in establishing the fee guidelines. |
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| 36 | 36 | | SECTION 2. This Act takes effect September 1, 2009. |
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