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A BILL TO BE ENTITLED
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AN ACT
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relating to a demonstration program for real-time processing of |
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workers' compensation authorizations of payment for medical |
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services and medical bills. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 412, Labor Code, is |
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amended by adding Section 412.0129 to read as follows: |
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Sec. 412.0129. AUTHORIZATION OF PAYMENT FOR MEDICAL |
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SERVICES AND MEDICAL BILLING REAL-TIME PROCESSING DEMONSTRATION |
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PROGRAM. (a) The office shall develop and implement a |
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demonstration program for processing workers' compensation |
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authorizations of payment for medical services and medical bills in |
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real-time. |
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(b) The demonstration program described by Subsection (a) |
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must include: |
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(1) a secure single platform, web-based portal for use |
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by the office, state agencies, injured employees, and health care |
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providers; |
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(2) the ability to collect, input, and transmit |
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administrative and clinical data, including: |
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(A) patient information; |
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(B) provider contracts; |
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(C) treatment guidelines; and |
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(D) other information the office considers |
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necessary for processing authorizations and medical bills; |
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(3) an automated process to streamline requests for |
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authorizations of payment for medical services and peer reviews at |
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the point of care; and |
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(4) return to work best practices for workers' |
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compensation claims, including complex case management. |
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(c) The office shall work with the workers' compensation |
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research and evaluation group to identify and adopt measures for |
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evaluating the demonstration program. |
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(d) The evaluation period for the demonstration program |
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shall end on June 30, 2020. |
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(e) Not later than December 31, 2020, the office shall |
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provide to the board a report that: |
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(1) evaluates the program, including any effects of |
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the program on administrative cost savings; and |
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(2) recommends whether to use the process implemented |
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under the program on a permanent basis. |
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(f) If the report of the demonstration program under |
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Subsection (e) indicates that administrative cost savings are |
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achieved by the process implemented under the program, the board |
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may adopt and use the process on a permanent basis. |
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(g) This section expires September 1, 2021. |
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SECTION 2. (a) Not later than January 1, 2018, the State |
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Office of Risk Management shall begin developing the demonstration |
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program under Section 412.0129, Labor Code, as added by this Act. |
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(b) Not later than January 1, 2019, the State Office of Risk |
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Management shall fully implement the demonstration program |
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developed under Section 412.0129, Labor Code, as added by this Act. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2017. |