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