HBA-ATS H.B. 1778 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1778 By: Giddings Business & Industry 3/10/1999 Introduced BACKGROUND AND PURPOSE The Texas Workers' Compensation Commission (commission) develops and administers programs to contain or reduce medical and legal costs and to ensure overall system efficiency. Implementation of these programs requires the commission to create medical policies relating to necessary treatments for injuries and guidelines relating to the fees charged or paid for medical services used by employees, and to establish a review process to resolve disputes concerning medical services rendered by a health care provider. To help the commission carry out these duties, the Labor Code currently authorizes it to contract with a health care provider professional review organization or other entity to develop, maintain, or review the medical policies or fee guidelines, including the compliance with these policies and guidelines. In addition, the commission is authorized to contract with a health care provider for medical consultant services, including independent medical examinations and medical case reviews. Currently, the commission contracts for medical consultant services to help determine the appropriateness of medical care given to an injured employee when the commission lacks medical expertise. Relying on these entities is expensive and may lengthen the medical review process in a dispute. Moreover, other decisions made by the commission that affect the timeliness and cost associated with medical care provided to an injured employee, such as verifying the accuracy of an impairment rating, may suffer because of the commission's lack of medical expertise. H.B. 1778 requires the Texas Workers' Compensation Commission to employ a medical advisor to develop, maintain, and review medical policies and fee guidelines and to review compliance with those policies and guidelines. The advisor must be a licensed individual who has extensive educational and clinical experience and training in health care. In addition, this bill authorizes a medical advisor to create a panel of physicians to assist the medical advisor. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 413, Labor Code, by adding Section 413.0515, as follows: Sec. 413.0515. MEDICAL ADVISORS. (a) Requires the Texas Workers' Compensation Commission (commission) to employ a medical advisor to develop, maintain, and review medical policies and fee guidelines and to review compliance with those policies and guidelines. (b) Authorizes a medical advisor to create a panel of physicians to assist the medical advisor in performing any review under Subsection (a). (c) Provides that a medical advisor or any physician serving on a panel under Subsection (b) is immune from liability for any act done by that person in good faith and in that person's official capacity. (d) Provides that a medical advisor must be a licensed individual who has extensive educational and clinical experience and training in health care, including diagnosis and treatment, surgical intervention, rehabilitation, and counseling of patients who have suffered an injury or disease. SECTION 2. This bill does not contain SECTION 2. SECTION 3. Effective date: September 1, 1999. SECTION 4. Emergency clause.