85R2857 KKR-D
By: Shine H.B. No. 3494
A BILL TO BE ENTITLED
AN ACT
relating to a demonstration program for real-time processing of
workers' compensation authorizations of payment for medical
services and medical bills.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 412, Labor Code, is
amended by adding Section 412.0129 to read as follows:
Sec. 412.0129. AUTHORIZATION OF PAYMENT FOR MEDICAL
SERVICES AND MEDICAL BILLING REAL-TIME PROCESSING DEMONSTRATION
PROGRAM. (a) The office shall develop and implement a
demonstration program for processing workers' compensation
authorizations of payment for medical services and medical bills in
real-time.
(b) The demonstration program described by Subsection (a)
must include:
(1) a secure single platform, web-based portal for use
by the office, state agencies, injured employees, and health care
providers;
(2) the ability to collect, input, and transmit
administrative and clinical data, including:
(A) patient information;
(B) provider contracts;
(C) treatment guidelines; and
(D) other information the office considers
necessary for processing authorizations and medical bills;
(3) an automated process to streamline requests for
authorizations of payment for medical services and peer reviews at
the point of care; and
(4) return to work best practices for workers'
compensation claims, including complex case management.
(c) The office shall work with the workers' compensation
research and evaluation group to identify and adopt measures for
evaluating the demonstration program.
(d) The evaluation period for the demonstration program
shall end on June 30, 2020.
(e) Not later than December 31, 2020, the office shall
provide to the board a report that:
(1) evaluates the program, including any effects of
the program on administrative cost savings; and
(2) recommends whether to use the process implemented
under the program on a permanent basis.
(f) If the report of the demonstration program under
Subsection (e) indicates that administrative cost savings are
achieved by the process implemented under the program, the board
may adopt and use the process on a permanent basis.
(g) This section expires September 1, 2021.
SECTION 2. (a) Not later than January 1, 2018, the State
Office of Risk Management shall begin developing the demonstration
program under Section 412.0129, Labor Code, as added by this Act.
(b) Not later than January 1, 2019, the State Office of Risk
Management shall fully implement the demonstration program
developed under Section 412.0129, Labor Code, as added by this Act.
SECTION 3. 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, 2017.