Bill Text: TX SB1322 | 2013-2014 | 83rd Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the provision of durable medical equipment and home health care services through informal and voluntary networks in the workers' compensation system; providing penalties.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2013-06-14 - Effective on 9/1/13 [SB1322 Detail]
Download: Texas-2013-SB1322-Comm_Sub.html
Bill Title: Relating to the provision of durable medical equipment and home health care services through informal and voluntary networks in the workers' compensation system; providing penalties.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Passed) 2013-06-14 - Effective on 9/1/13 [SB1322 Detail]
Download: Texas-2013-SB1322-Comm_Sub.html
By: Van de Putte | S.B. No. 1322 | |
(In the Senate - Filed March 7, 2013; March 13, 2013, read | ||
first time and referred to Committee on State Affairs; | ||
April 30, 2013, reported adversely, with favorable Committee | ||
Substitute by the following vote: Yeas 8, Nays 0; April 30, 2013, | ||
sent to printer.) | ||
COMMITTEE SUBSTITUTE FOR S.B. No. 1322 | By: Van de Putte |
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relating to the provision of durable medical equipment and home | ||
health care services through informal and voluntary networks in the | ||
workers' compensation system; providing penalties. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subsection (f), Section 408.027, Labor Code, is | ||
amended to read as follows: | ||
(f) Except as provided by Section 408.0281 or 408.0284, any | ||
payment made by an insurance carrier under this section shall be in | ||
accordance with the fee guidelines authorized under this subtitle | ||
if the health care service is not provided through a workers' | ||
compensation health care network under Chapter 1305, Insurance | ||
Code, or at a contracted rate for that health care service if the | ||
health care service is provided through a workers' compensation | ||
health care network under Chapter 1305, Insurance Code. | ||
SECTION 2. Subsection (a), Section 408.0282, Labor Code, is | ||
amended to read as follows: | ||
(a) Each informal or voluntary network described by Section | ||
408.0281 or 408.0284 shall, not later than the 30th day after the | ||
date the network is established, report the following information | ||
to the division: | ||
(1) the name of the informal or voluntary network and | ||
federal employer identification number; | ||
(2) an executive contact for official correspondence | ||
for the informal or voluntary network; | ||
(3) a toll-free telephone number by which a health | ||
care provider may contact the informal or voluntary network; | ||
(4) a list of each insurance carrier with whom the | ||
informal or voluntary network contracts, including the carrier's | ||
federal employer identification number; and | ||
(5) a list of, and contact information for, each | ||
entity with which the informal or voluntary network has a contract | ||
or other business relationship that benefits or is entered into on | ||
behalf of an insurance carrier, including an insurance carrier's | ||
authorized agent or a subsidiary or other affiliate of the network. | ||
SECTION 3. Subchapter B, Chapter 408, Labor Code, is | ||
amended by adding Section 408.0284 to read as follows: | ||
Sec. 408.0284. REIMBURSEMENT FOR DURABLE MEDICAL EQUIPMENT | ||
AND HOME HEALTH CARE SERVICES; ADMINISTRATIVE VIOLATION. (a) In | ||
this section: | ||
(1) "Durable medical equipment" includes prosthetics | ||
and orthotic devices and related medical equipment and supplies. | ||
The term does not include: | ||
(A) an object or device that is surgically | ||
implanted, embedded, inserted, or otherwise applied; | ||
(B) related equipment necessary to operate, | ||
program, or recharge the object or device described by Paragraph | ||
(A); or | ||
(C) an intrathecal pump. | ||
(2) "Informal network" means a network that: | ||
(A) is established under a contract between an | ||
insurance carrier or an insurance carrier's authorized agent and a | ||
health care provider for the provision of durable medical equipment | ||
or home health care services; and | ||
(B) includes a specific fee schedule. | ||
(3) "Voluntary network" means a voluntary workers' | ||
compensation health care delivery network established under former | ||
Section 408.0223, as that section existed before repeal by Chapter | ||
265 (House Bill No. 7), Acts of the 79th Legislature, Regular | ||
Session, 2005, by an insurance carrier for the provision of durable | ||
medical equipment or home health care services. | ||
(b) Notwithstanding any provision of Chapter 1305, | ||
Insurance Code, or Section 504.053 of this code, durable medical | ||
equipment and home health care services may be reimbursed in | ||
accordance with the fee guidelines adopted by the commissioner or | ||
at a voluntarily negotiated contract rate in accordance with this | ||
section. | ||
(c) Notwithstanding any other provision of this title or any | ||
provision of Chapter 1305, Insurance Code, an insurance carrier may | ||
pay a health care provider fees for durable medical equipment or | ||
home health care services that are inconsistent with the fee | ||
guidelines adopted by the commissioner only if the carrier or the | ||
carrier's authorized agent has a contract with the health care | ||
provider and that contract includes a specific fee schedule. An | ||
insurance carrier or the carrier's authorized agent may use an | ||
informal or voluntary network to obtain a contractual agreement | ||
that provides for fees different from the fees authorized under the | ||
fee guidelines adopted by the commissioner for durable medical | ||
equipment or home health care services. If a carrier or the | ||
carrier's authorized agent chooses to use an informal or voluntary | ||
network to obtain a contractual fee arrangement, there must be a | ||
contractual arrangement between: | ||
(1) the carrier or authorized agent and the informal | ||
or voluntary network that authorizes the network to contract with | ||
health care providers for durable medical equipment or home health | ||
care services on the carrier's behalf; and | ||
(2) the informal or voluntary network and the health | ||
care provider that includes a specific fee schedule and complies | ||
with the notice requirements of this section. | ||
(d) An informal or voluntary network, or the carrier or the | ||
carrier's authorized agent shall, at least quarterly, notify each | ||
health care provider of any person, other than an injured employee, | ||
to which the network's contractual fee arrangements with the health | ||
care provider are sold, leased, transferred, or conveyed. Notice | ||
to each health care provider: | ||
(1) must include: | ||
(A) the contact information for the network, | ||
including the name, physical address, and toll-free telephone | ||
number at which a health care provider with which the network has a | ||
contract may contact the network; and | ||
(B) in the body of the notice: | ||
(i) the name, physical address, and | ||
telephone number of any person, other than an injured employee, to | ||
which the network's contractual fee arrangement with the health | ||
care provider is sold, leased, transferred, or conveyed; and | ||
(ii) the start date and any end date of the | ||
period during which the network's contractual fee arrangement with | ||
the health care provider is sold, leased, transferred, or conveyed; | ||
and | ||
(2) may be provided: | ||
(A) in an electronic format, if a paper version | ||
is available on request by the division; and | ||
(B) through an Internet website link, but only if | ||
the website: | ||
(i) contains the information described by | ||
Subdivision (1); and | ||
(ii) is updated at least monthly with | ||
current and correct information. | ||
(e) An informal or voluntary network, or the carrier or the | ||
carrier's authorized agent, as appropriate, shall document the | ||
delivery of the notice required under Subsection (d), including the | ||
method of delivery, to whom the notice was delivered, and the date | ||
of delivery. For purposes of Subsection (d), a notice is considered | ||
to be delivered on, as applicable: | ||
(1) the fifth day after the date the notice is mailed | ||
via United States Postal Service; or | ||
(2) the date the notice is faxed or electronically | ||
delivered. | ||
(f) An insurance carrier, or the carrier's authorized agent | ||
or an informal or voluntary network at the carrier's request, shall | ||
provide copies of each contract described by Subsection (c) to the | ||
division on the request of the division. Information included in a | ||
contract under Subsection (c) is confidential and is not subject to | ||
disclosure under Chapter 552, Government Code. Notwithstanding | ||
Subsection (c), the insurance carrier may be required to pay fees in | ||
accordance with the division's fee guidelines if: | ||
(1) the contract: | ||
(A) is not provided to the division on the | ||
division's request; | ||
(B) does not include a specific fee schedule | ||
consistent with Subsection (c); or | ||
(C) does not clearly state that the contractual | ||
fee arrangement is between the health care provider and the named | ||
insurance carrier or the carrier's authorized agent; or | ||
(2) the carrier or the carrier's authorized agent does | ||
not comply with the notice requirements under Subsection (d). | ||
(g) Failure to provide documentation described by | ||
Subsection (e) to the division on the request of the division or | ||
failure to provide notice as required under Subsection (d) creates | ||
a rebuttable presumption in an enforcement action under this | ||
subtitle and in a medical fee dispute under Chapter 413 that a | ||
health care provider did not receive the notice. | ||
(h) An insurance carrier or the carrier's authorized agent | ||
commits an administrative violation if the carrier or agent | ||
violates any provision of this section. Any administrative penalty | ||
assessed under this subsection shall be assessed against the | ||
carrier, regardless of whether the carrier or agent committed the | ||
violation. | ||
(i) Notwithstanding Section 1305.003(b), Insurance Code, in | ||
the event of a conflict between this section and Section 413.016 or | ||
any other provision of Chapter 413 of this code or Chapter 1305, | ||
Insurance Code, this section prevails. | ||
SECTION 4. Each informal or voluntary network described by | ||
Section 408.0284, Labor Code, as added by this Act, that has a | ||
contract between an insurance carrier or an insurance carrier's | ||
authorized agent and a health care provider that is in effect on the | ||
effective date of this Act shall file the report described by | ||
Subsection (a), Section 408.0282, Labor Code, as amended by this | ||
Act, not later than the 30th day after the effective date of this | ||
Act. | ||
SECTION 5. With respect to a contractual agreement that | ||
provides for fees for durable medical equipment or home health care | ||
services that are different from the fees authorized under the fee | ||
guidelines adopted by the commissioner of workers' compensation | ||
under Title 5, Labor Code, and that is entered into after the | ||
effective date of this Act, the notice required under Subsection | ||
(d), Section 408.0284, Labor Code, as added by this Act, shall be | ||
sent not later than the 30th day after the effective date of the | ||
contract, and subsequent notices required under that section shall | ||
be sent on a quarterly basis. | ||
SECTION 6. If any provision of this Act or its application | ||
to any person or circumstance is held invalid, the invalidity does | ||
not affect other provisions or applications of this Act that can be | ||
given effect without the invalid provision or application, and to | ||
this end the provisions of this Act are severable. | ||
SECTION 7. This Act takes effect September 1, 2013. | ||
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