86R29669 KKR-D
By: Shine, Darby, Parker H.B. No. 2919
Substitute the following for H.B. No. 2919:
By: Darby C.S.H.B. No. 2919
A BILL TO BE ENTITLED
AN ACT
relating to a demonstration program at the State Office of Risk
Management 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 BILLS REAL-TIME PROCESSING DEMONSTRATION
PROGRAM. (a) The office may develop and implement a demonstration
program for processing workers' compensation authorizations of
payment for medical services and medical bills in real time if the
office determines that the program would be cost-effective.
(b) The demonstration program described by Subsection (a)
must include:
(1) a secure single platform, Internet-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 workers' compensation research and evaluation group
may assist the office in identifying and adopting measures for
evaluating the demonstration program.
(d) The evaluation period for the demonstration program
shall end on June 30, 2022.
(e) If the office implements a demonstration program under
this section, not later than December 31, 2022, 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) If the report of the demonstration program under
Subsection (e) indicates that administrative cost savings were not
achieved by the process implemented under the program, not later
than December 31, 2022, the office shall submit to the legislature a
written report that contains:
(1) the reasons that the program did not result in
administrative cost savings; and
(2) recommendations for proposed legislation to
develop a cost-effective system for processing workers'
compensation authorizations of payment for medical services and
medical bills in real time.
(h) This section expires September 1, 2023.
SECTION 2. Not later than January 1, 2020, the State Office
of Risk Management shall study and make a determination as to
whether the demonstration program described by Section 412.0129,
Labor Code, as added by this Act, would be cost-effective. If the
office determines the program would be cost-effective and decides
to implement the program, the office shall fully implement the
program not later than January 1, 2021.
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, 2019.