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.