Texas 2025 - 89th Regular

Texas House Bill HB4676 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R9000 KKR-F
2	2	By: Turner H.B. No. 4676
3	3
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the provision of medical benefits through political
10	10	subdivision networks under the workers' compensation system.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 504.001, Labor Code, is amended by
13	13	adding Subdivisions (1-a) and (3-a) to read as follows:
14	14	(1-a) "Complaint," "independent review," "medical
15	15	emergency," "mental health emergency," "rural area," "service
16	16	area," and "utilization review" have the meanings assigned by
17	17	Section 1305.004, Insurance Code.
18	18	(3-a) "Political subdivision network" means an
19	19	organization formed by the political subdivision or pool directly
20	20	contracting with health care providers or by contracting through a
21	21	health benefits pool established under Chapter 172, Local
22	22	Government Code, to provide medical benefits to a political
23	23	subdivision's injured employees or the injured employees of the
24	24	members of the pool.
25	25	SECTION 2. Section 504.053, Labor Code, is amended by
26	26	amending Subsections (b), (c), (d), and (e) and adding Subsections
27	27	(f), (g), and (h) to read as follows:
28	28	(b) If a political subdivision or a pool determines that a
29	29	workers' compensation health care network certified under Chapter
30	30	1305, Insurance Code, is not available or practical for the
31	31	political subdivision or pool, the political subdivision or pool
32	32	may provide medical benefits to its injured employees or to the
33	33	injured employees of the members of the pool:
34	34	(1) in the manner provided by Chapter 408, other than
35	35	Sections 408.001(b) and (c) and Section 408.002, and by Subchapters
36	36	B and C, Chapter 413; or
37	37	(2) through a political subdivision network [by
38	38	directly contracting with health care providers or by contracting
39	39	through a health benefits pool established under Chapter 172, Local
40	40	Government Code].
41	41	(c) If the political subdivision or pool provides medical
42	42	benefits through a political subdivision network as [in the manner]
43	43	authorized under Subsection (b)(2), the following do not apply:
44	44	(1) Sections 408.004 and 408.0041, unless use of a
45	45	required medical examination or designated doctor is necessary to
46	46	resolve an issue relating to the entitlement to or amount of income
47	47	benefits under this title;
48	48	(2) Subchapter B, Chapter 408, except for Section
49	49	408.021;
50	50	(3) Chapter 413, except for Section 413.042; and
51	51	(4) Chapter 1305, Insurance Code, except as otherwise
52	52	provided by this section [for Sections 1305.501, 1305.502, and
53	53	1305.503].
54	54	(d) If the political subdivision or pool provides medical
55	55	benefits through a political subdivision network as [in the manner]
56	56	authorized under Subsection (b)(2), the following standards apply:
57	57	(1) the political subdivision or pool must ensure that
58	58	workers' compensation medical benefits are reasonably available to
59	59	all injured employees [workers] of the political subdivision or the
60	60	injured employees [workers] of the members of the pool within the
61	61	political subdivision network's [a designed] service area;
62	62	(2) the political subdivision or pool must ensure that
63	63	all necessary health care services are provided in a manner that
64	64	complies with Section 1305.302, Insurance Code, and that will
65	65	ensure the availability of and accessibility to a sufficient number
66	66	of [adequate] health care providers, specialty care, and facilities
67	67	in both rural and nonrural areas;
68	68	(3) the political subdivision or pool must have an
69	69	internal review process for resolving complaints relating to the
70	70	manner of providing medical benefits, including a process for the
71	71	notice and appeal of a complaint that complies with Subchapter I,
72	72	Chapter 1305, Insurance Code [an appeal to the governing body or its
73	73	designee and appeal to an independent review organization];
74	74	(4) the political subdivision or pool must establish
75	75	reasonable procedures for the transition of injured employees
76	76	[workers] to contract providers and for the continuity of
77	77	treatment, including notice of impending termination of providers
78	78	and a current list of contract providers;
79	79	(5) the availability and accessibility of care for a
80	80	medical emergency or a mental health emergency must comply with
81	81	Section 1305.302, Insurance Code [the political subdivision or pool
82	82	shall provide for emergency care if an injured worker cannot
83	83	reasonably reach a contract provider and the care is for medical
84	84	screening or other evaluation that is necessary to determine
85	85	whether a medical emergency condition exists, necessary emergency
86	86	care services including treatment and stabilization, and services
87	87	originating in a hospital emergency facility following treatment or
88	88	stabilization of an emergency medical condition];
89	89	(6) utilization [prospective or concurrent] review
90	90	and independent review of the medical necessity and appropriateness
91	91	of health care services must comply with Chapters 4201 and 4202
92	92	[Article 21.58A], Insurance Code, and applicable rules adopted by
93	93	the commissioner of insurance and the commissioner of workers'
94	94	compensation;
95	95	(7) the political subdivision or pool shall continue
96	96	to report data to the appropriate agency as required by Title 5 of
97	97	this code and Chapter 1305, Insurance Code; [and]
98	98	(8) a political subdivision or pool is also subject to
99	99	the requirements under Subchapters K and L, Chapter 1305 [Sections
100	100	1305.501, 1305.502, and 1305.503], Insurance Code; and
101	101	(9) the political subdivision or pool must comply with
102	102	the employee notice requirements under Sections 1305.005(d)-(h)
103	103	and 1305.451, Insurance Code, and any dispute regarding an
104	104	employee's receipt of a required network notice under those
105	105	sections may be resolved under Chapter 410 of this code.
106	106	(e) Nothing in this chapter waives sovereign immunity or
107	107	creates a new cause of action, except that a political subdivision
108	108	that self-insures either individually or collectively is liable
109	109	for:
110	110	(1) sanctions, administrative penalties, and other
111	111	remedies authorized under Chapter 415;
112	112	(1-a) sanctions, emergency orders, and administrative
113	113	penalties as provided under Chapters 82, 83, and 84, Insurance
114	114	Code;
115	115	(2) attorney's fees as provided by Section 408.221(c);
116	116	and
117	117	(3) attorney's fees as provided by Section 417.003.
118	118	(f) Nothing in this section requires a political
119	119	subdivision network to be certified under Chapter 1305, Insurance
120	120	Code.
121	121	(g) The commissioner of insurance:
122	122	(1) shall monitor political subdivision networks to
123	123	ensure and enforce compliance with this section, the applicable
124	124	provisions of Chapter 1305, Insurance Code, and commissioner rules;
125	125	and
126	126	(2) may impose sanctions, issue emergency orders, and
127	127	assess administrative penalties as provided under Chapters 82, 83,
128	128	and 84, Insurance Code, on a political subdivision network for
129	129	failing to comply with those laws and rules.
130	130	(h) The commissioner of insurance and the commissioner of
131	131	workers' compensation may adopt rules as necessary to implement
132	132	this section.
133	133	SECTION 3. Subchapter C, Chapter 504, Labor Code, is
134	134	amended by adding Section 504.0531 to read as follows:
135	135	Sec. 504.0531. INTENT OF ELECTION TO PROVIDE MEDICAL
136	136	BENEFITS THROUGH POLITICAL SUBDIVISION NETWORKS. The purpose of
137	137	Section 504.053 is to:
138	138	(1) provide political subdivisions or pools options
139	139	for providing medical benefits to injured employees when a
140	140	political subdivision determines in good faith that using a network
141	141	certified under Chapter 1305, Insurance Code, is not available or
142	142	practical; and
143	143	(2) ensure that injured employees who receive medical
144	144	benefits through political subdivision networks:
145	145	(A) are notified of their rights under a network;
146	146	and
147	147	(B) have the same access to and choices for
148	148	health care as injured employees who receive medical benefits
149	149	through certified networks under Chapter 1305, Insurance Code.
150	150	SECTION 4. Section 504.054(a), Labor Code, is amended to
151	151	read as follows:
152	152	(a) A party to a medical dispute that remains unresolved
153	153	after the independent review described by Section 504.053(d)(6)
154	154	[504.053(d)(3)] is entitled to a contested case hearing. A hearing
155	155	under this subsection shall be conducted by the division in the same
156	156	manner as a hearing conducted under Section 413.0311.
157	157	SECTION 5. Not later than December 31, 2026, the
158	158	commissioner of insurance shall provide to the legislature a
159	159	written recommendation on whether political subdivision networks
160	160	should be required to be certified by the Texas Department of
161	161	Insurance.
162	162	SECTION 6. Section 504.053(e), Labor Code, as amended by
163	163	this Act, applies only to an administrative violation that occurs
164	164	on or after the effective date of this Act.
165	165	SECTION 7. This Act takes effect January 1, 2026.