82R10744 JSC-F
By: Madden H.B. No. 2634
A BILL TO BE ENTITLED
AN ACT
relating to extending workers' compensation benefits for certain
state employees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 501, Labor Code, is
amended by adding Section 501.0451 to read as follows:
Sec. 501.0451. ELECTION. (a) The office may elect to
provide workers' compensation medical benefits to employees
through a health care network certified under Chapter 1305,
Insurance Code, if the office determines that provision of those
benefits through a network is:
(1) available to the employees; and
(2) practical for the state.
(b) If the office determines that a workers' compensation
health care network certified under Chapter 1305, Insurance Code,
is not available or practical for the state, the office may provide
medical benefits to employees:
(1) in the manner provided by Chapter 408, other than
Sections 408.001(b) and (c) and 408.002, and by Subchapters B and C,
Chapter 413; or
(2) by contracting with health care providers in a
manner consistent with this section.
(c) If the office provides medical benefits in the manner
authorized by Subsection (b)(2), the following provisions do not
apply:
(1) Sections 408.001 and 408.0041, unless use of a
required medical examination or designated doctor is necessary to
resolve an issue relating to the entitlement to or amount of income
benefits under this title;
(2) Subchapter B, Chapter 408, except for Section
408.021;
(3) Chapter 413, except for Section 413.042; and
(4) Chapter 1305, Insurance Code, except for
Subchapter K.
(d) If the office provides medical benefits in the manner
authorized by Subsection (b)(2), the following standards apply:
(1) the office must ensure that workers' compensation
medical benefits are reasonably available to all covered employees
within a service area;
(2) the office must ensure that all necessary health
care services are provided in a manner that will ensure the
availability of and accessibility to adequate health care
providers, specialty care, and facilities;
(3) the office must have an internal review process
for resolving complaints relating to the manner of providing
medical benefits, including an appeal to the governing body or its
designee and an appeal to an independent review organization;
(4) the office must establish reasonable procedures
for the transition of injured workers to contract providers and for
the continuity of treatment, including notice of impending
termination of providers and a current list of contract providers;
(5) the office shall provide for emergency care if an
injured worker cannot reasonably reach a contract provider and the
care is for:
(A) a medical screening or other evaluation that
is necessary to determine whether a medical emergency condition
exists;
(B) necessary emergency care services, including
treatment and stabilization; or
(C) services originating in a hospital emergency
facility following treatment or stabilization of an emergency
medical condition;
(6) prospective or concurrent review of the medical
necessity and appropriateness of health care services must comply
with Chapter 4201, Insurance Code;
(7) the office shall continue to report data to the
appropriate agency as required by this title and Chapter 1305,
Insurance Code; and
(8) the office is subject to the requirements of
Subchapter K, Chapter 1305, Insurance Code.
(e) The office has exclusive authority to provide health
care services under this chapter to employees:
(1) in the manner authorized by this section; or
(2) by contracting with networks under Chapter 1305,
Insurance Code.
(f) This chapter does not waive sovereign immunity or create
a new cause of action.
SECTION 2. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2011.