HBA- DMD, MPA H.B. 2512 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 2512 By: Giddings Business & Industry 7/27/1999 Enrolled BACKGROUND AND PURPOSE Prior to the 76th Legislature, the Texas Workers' Compensation Act authorized a Texas Workers' Compensation Commission (commission) benefit review officer (BRO), at a benefit review conference, to enter interlocutory (temporary) orders for an insurance carrier to pay benefits to an injured worker. BROs did not enter limited interlocutory orders, instead these orders were for all accrued medical and income benefits, or no benefits. An award of all accrued medical benefits could amount to a substantial sum of money, making a BRO reluctant to enter an order. If an interlocutory order was overturned at a contested case hearing, a carrier may have sought reimbursement from the commission's subsequent injury fund (SIF). Hearing officers did not have the authority to enter interlocutory orders, and there was no provision for reimbursement if the hearing officer's decision was overturned. Several specific treatments and services required carrier pre-authorization, or pre-approval, before being administered to an injured worker. If a treatment or service was denied an injured worker may have had to wait months pending the outcome of the medical review process. The executive director of the commission did not have the authority to enter interlocutory orders in these cases. H.B. 2512 clarifies that either a BRO at a benefit review conference or a hearing officer at a contested case hearing has the discretion to enter limited interlocutory order to pay benefits, and allows insurance carriers to seek recovery of overpayments if the order is overturned. This bill also authorizes the executive director of the commission to enter interlocutory orders to ensure that essential medical benefits are provided pending the outcome of a formal hearing, which would be reviewed under the Administrative Procedure Act (Chapter 2001, Government Code). An insurance carrier making payments under this order would have the right to seek reimbursement from the SIF if the order is subsequently overturned. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Workers' Compensation Commission in SECTION 5 (Section 410.209, Labor Code) and SECTION 6 (Section 413.055, Labor Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 402.073(b), Labor Code, to make a conforming change. SECTION 2. Amends Section 410.032, Labor Code, to authorize a benefit review officer to issue an interlocutory order for payment of all or part of medical benefits or income benefits, including accrued benefits, future benefits or both, if the officer recommends that benefits be paid or not paid. Makes conforming changes. SECTION 3. Amends Section 410.168, Labor Code, to authorize the hearing officer's written decision to address accrued benefits, future benefits, or both accrued and future benefits. Authorizes the hearing officer to enter into an interlocutory order for payment of all or part of medical benefits or income benefits, including accrued benefits, future benefits or both, which is binding during the pendency of an appeal to the appeals panel. Redesignates Subsections (b)-(d) to Subsections (d)-(f). SECTION 4. Amends Section 410.205, Labor Code, as follows: Sec. 410.205. New Title: EFFECT OF DECISION. Makes conforming changes. SECTION 5. Amends Subchapter E, Chapter 410, Labor Code, by adding Section 410.209, as follows: Sec. 410.209. REIMBURSEMENT FOR OVERPAYMENT. Requires the subsequent injury fund to reimburse an insurance carrier for any overpayments of benefits made under an interlocutory order or decision that is later reversed or modified by final arbitration, order, or decision of the Texas Workers' Compensation Commission (commission) or court. Requires the commission, by rule, to provide for a periodic reimbursement schedule, with reimbursements made not less than annually. SECTION 6. Amends Subchapter E, Chapter 413, Labor Code, by adding Section 413.055, as follows: Sec. 413.055. INTERLOCUTORY ORDERS; REIMBURSEMENT. (a) Authorizes the executive director of the commission to enter an interlocutory order for payment of all or part of the medical expenses as provided by commission rules. Authorizes the order to address accrued benefits, future benefits, or both accrued and future benefits. (b) Requires the subsequent injury fund to reimburse an insurance carrier for any overpayments of benefits made under an interlocutory order or decision that is later reversed or modified by final arbitration, order, or decision of the commission or court. Requires the commission, by rule, to provide for a periodic reimbursement schedule, with reimbursements made not less than annually. (c) Provides that a party that disputes an order entered under Subsection (a) is entitled to a hearing. Requires the hearing to be conducted by the State Office of Administrative Hearings in the manner provided for a contested hearing in Chapter 2001 (Administrative Procedure), Government Code. Provides that the order is binding during the pendency of the appeal. SECTION 7.Effective date: September 1, 1999. Makes application of this Act prospective. SECTION 8.Emergency clause.