87R6779 JSC-F
By: Oliverson H.B. No. 1339
A BILL TO BE ENTITLED
AN ACT
relating to benefit review conferences and certain required reports
under the Texas workers' compensation system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1305.502(a), Insurance Code, is amended
to read as follows:
(a) Not later than December 1 of each even-numbered year,
the [The] group shall develop and issue an [annual] informational
report card that identifies and compares, on an objective basis,
the quality, costs, health care provider availability, and other
analogous factors of workers' compensation health care networks
operating under the workers' compensation system of this state with
each other and with medical care provided outside of networks.
SECTION 2. The heading to Section 410.005, Labor Code, is
amended to read as follows:
Sec. 410.005. CONDUCTING [VENUE FOR] ADMINISTRATIVE
PROCEEDINGS.
SECTION 3. Section 410.005, Labor Code, is amended by
amending Subsections (a) and (d) and adding Subsection (e) to read
as follows:
(a) Unless the division determines that good cause exists
for the selection of a different location, [a benefit review
conference or] a contested case hearing may not be conducted at a
site more than 75 miles from the claimant's residence at the time of
the injury.
(d) The [Notwithstanding Subsection (a), the] division may
conduct a benefit review conference:
(1) telephonically;
(2) by videoconference; or
(3) in person, on showing of good cause as determined
by the division [on agreement by the injured employee].
(e) Unless the division determines that good cause exists
for the selection of a different location, a benefit review
conference conducted in person under Subsection (d)(3) may not be
conducted at a site more than 75 miles from the claimant's residence
at the time of the injury.
SECTION 4. Sections 504.053(c) and (d), Labor Code, are
amended to read as follows:
(c) If the political subdivision or pool provides medical
benefits in the manner authorized under Subsection (b)(2), the
following do not apply:
(1) Sections 408.004 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 Sections
[1305.501,] 1305.502[,] and 1305.503.
(d) If the political subdivision or pool provides medical
benefits in the manner authorized under Subsection (b)(2), the
following standards apply:
(1) the political subdivision or pool must ensure that
workers' compensation medical benefits are reasonably available to
all injured workers of the political subdivision or the injured
workers of the members of the pool within a designed service area;
(2) the political subdivision or pool 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 political subdivision or pool 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 appeal to an independent review
organization;
(4) the political subdivision or pool 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 political subdivision or pool shall provide
for emergency care if an injured worker cannot reasonably reach a
contract provider and the care is for medical screening or other
evaluation that is necessary to determine whether a medical
emergency condition exists, necessary emergency care services
including treatment and stabilization, and 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 Article 21.58A, Insurance Code;
(7) the political subdivision or pool shall continue
to report data to the appropriate agency as required by Title 5 of
this code and Chapter 1305, Insurance Code; and
(8) a political subdivision or pool is subject to the
requirements under Sections [1305.501,] 1305.502[,] and 1305.503,
Insurance Code.
SECTION 5. The following provisions are repealed:
(1) Section 1305.501, Insurance Code;
(2) Section 2053.012, Insurance Code; and
(3) Sections 405.0025(b) and (c), Labor Code.
SECTION 6. Section 410.005, Labor Code, as amended by this
Act, applies to a benefit review conference requested on or after
the effective date of this Act. A benefit review conference
requested before the effective date of this Act is governed by the
law in effect on the date the benefit review conference was
requested, and the former law is continued in effect for that
purpose.
SECTION 7. 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, 2021.