82R8683 JSC-D
By: Zedler H.B. No. 3429
A BILL TO BE ENTITLED
AN ACT
relating to preauthorization of certain medical services in the
workers' compensation system and the eligibility of doctors,
dentists, and chiropractors to perform preauthorization
utilization review.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1305.351, Insurance Code, is amended by
adding Subsection (e) to read as follows:
(e) If a network or insurance carrier uses a
preauthorization process within the network, not later than the
30th day after the date of making a decision regarding a request for
preauthorization, the network or carrier shall submit to the
division of workers' compensation of the department:
(1) a statement of:
(A) whether the network or carrier approved,
approved in part, or denied the request for preauthorization; and
(B) the reason the network or carrier made the
decision under Paragraph (A); and
(2) any relevant supporting material, including any
reports by medical professionals who reviewed the case.
SECTION 2. Section 408.0043, Labor Code, is amended by
adding Subsection (c) to read as follows:
(c) A doctor who performs preauthorization utilization
review for an insurance network or carrier must:
(1) maintain the doctor's primary practice location in
this state; and
(2) earn at least 50 percent of the doctor's annual
income from the practice of treating patients.
SECTION 3. Section 408.0044, Labor Code, is amended by
adding Subsection (c) to read as follows:
(c) A dentist who performs preauthorization utilization
review for an insurance network or carrier must:
(1) maintain the dentist's primary practice location
in this state; and
(2) earn at least 50 percent of the dentist's annual
income from the practice of treating patients.
SECTION 4. Section 408.0045, Labor Code, is amended by
adding Subsection (c) to read as follows:
(c) A chiropractor who performs preauthorization
utilization review for an insurance network or carrier must:
(1) maintain the chiropractor's primary practice
location in this state; and
(2) earn at least 50 percent of the chiropractor's
annual income from the practice of treating patients.
SECTION 5. Section 413.014, Labor Code, is amended by
adding Subsection (g) to read as follows:
(g) Not later than the 30th day after the date of making a
decision regarding a request for preauthorization, the insurance
carrier shall submit to the division:
(1) a statement of:
(A) whether the carrier approved, approved in
part, or denied the request for preauthorization; and
(B) the reason the carrier made the decision
under Paragraph (A); and
(2) any relevant supporting material, including any
reports by medical professionals who reviewed the case.
SECTION 6. The change in law made by this Act applies to a
preauthorization request in connection with a claim for workers'
compensation benefits that is made on or after the effective date of
this Act. A preauthorization request that was made before that date
is governed by the law in effect when the request was made, and the
former law is continued in effect for that purpose.
SECTION 7. This Act takes effect September 1, 2011.