Texas Senate Bill SB2200

Texas 2009 - 81st Regular

Caption

Relating to retrospective utilization review and utilization review to determine the experimental or investigational nature of a health care service.

Impact

The proposed changes are positioned to enhance oversight in the utilization review process. This includes allowing health care providers the opportunity to discuss treatment plans before adverse determinations are made, thereby fostering communication between providers and reviewers. The bill mandates that utilization review agents must comply with the determinations made by independent review organizations, adding an additional layer of accountability in the review process. These amendments would particularly impact how employees access their rights to health care services under workers' compensation laws, emphasizing a patient-centered approach.

Summary

SB2200 proposes amendments to the Texas Insurance Code and the Labor Code, specifically focusing on the processes of retrospective utilization review and the determination of whether certain health care services are experimental or investigational. The bill aims to update definitions related to 'adverse determination', 'independent review', and 'screening criteria' that govern the evaluation of medical services provided to employees in the context of workers' compensation. By refining these terms, the bill seeks to bring clarity and consistency in health care coverage assessment processes, potentially impacting both health care providers and employees seeking benefits.

Contention

While supporters argue that SB2200 will improve the quality of care and ensure fair assessments of health services, there are concerns about the rigorous standards that may be set for health care providers. Critics may view the bill as limiting insurance carriers' ability to make cost-effective decisions in managing claims. The potential increase in approval rates for treatments deemed experimental could lead to escalated costs for insurance networks, prompting debates about the financial ramifications of such policies. Therefore, the ongoing discussions reflect differing perspectives on the balance between access to necessary treatments and fiscal responsibility within the health care system.