82R1480 KCR-F
By: Menendez H.B. No. 1069
A BILL TO BE ENTITLED
AN ACT
relating to the provision of and payment for certain health care
services provided through workers' compensation health care
networks to fire protection personnel.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1305.006, Insurance Code, is amended to
read as follows:
Sec. 1305.006. INSURANCE CARRIER LIABILITY FOR NON-NETWORK
OR OUT-OF-NETWORK HEALTH CARE. (a) An insurance carrier that
establishes or contracts with a network is liable for the following
out-of-network health care that is provided to an injured employee:
(1) emergency care;
(2) health care provided to an injured employee who
does not live within the service area of any network established by
the insurance carrier or with which the insurance carrier has a
contract; and
(3) health care provided by an out-of-network provider
pursuant to a referral from the injured employee's treating doctor
that has been approved by the network pursuant to Section 1305.103.
(b) An insurance carrier that establishes or contracts with
a network is liable for out-of-network health care or non-network
health care that is provided to an injured employee who is diagnosed
with cancer related to work performed by the employee as fire
protection personnel, as defined by Section 419.021, Government
Code, regardless of whether the health care services are provided
in the manner described by Subsection (a)(3).
SECTION 2. Section 1305.101(a), Insurance Code, is amended
to read as follows:
(a) Except for emergencies and out-of-network referrals and
subject to Section 1305.006(b), a network shall provide or arrange
for health care services only through providers or provider groups
that are under contract with or are employed by the network.
SECTION 3. Section 408.027(f), Labor Code, is amended to
read as follows:
(f) Any payment made by an insurance carrier under this
section shall be made:
(1) in accordance with the fee guidelines authorized
under this subtitle if the health care service is not provided
through a workers' compensation health care network under Chapter
1305, Insurance Code, including an out-of-network or non-network
health care service provided to an injured employee in accordance
with Section 1305.006(b), Insurance Code; or
(2) at a contracted rate for that health care service
if the health care service is provided through a workers'
compensation health care network under Chapter 1305, Insurance
Code.
SECTION 4. The changes in law made by this Act apply only to
health care services provided on or after the effective date of this
Act in conjunction with a claim for workers' compensation benefits,
regardless of the date on which the compensable injury that is the
basis of the claim occurred.
SECTION 5. This Act takes effect September 1, 2011.