Bill Text: TX HB1069 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to the provision of and payment for certain health care services provided through workers' compensation health care networks to fire protection personnel.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-03-24 - No action taken in committee [HB1069 Detail]
Download: Texas-2011-HB1069-Introduced.html
| 82R1480 KCR-F | ||
| By: Menendez | H.B. No. 1069 | |
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| relating to the provision of and payment for certain health care | ||
| services provided through workers' compensation health care | ||
| networks to fire protection personnel. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Section 1305.006, Insurance Code, is amended to | ||
| read as follows: | ||
| Sec. 1305.006. INSURANCE CARRIER LIABILITY FOR NON-NETWORK | ||
| OR OUT-OF-NETWORK HEALTH CARE. (a) An insurance carrier that | ||
| establishes or contracts with a network is liable for the following | ||
| out-of-network health care that is provided to an injured employee: | ||
| (1) emergency care; | ||
| (2) health care provided to an injured employee who | ||
| does not live within the service area of any network established by | ||
| the insurance carrier or with which the insurance carrier has a | ||
| contract; and | ||
| (3) health care provided by an out-of-network provider | ||
| pursuant to a referral from the injured employee's treating doctor | ||
| that has been approved by the network pursuant to Section 1305.103. | ||
| (b) An insurance carrier that establishes or contracts with | ||
| a network is liable for out-of-network health care or non-network | ||
| health care that is provided to an injured employee who is diagnosed | ||
| with cancer related to work performed by the employee as fire | ||
| protection personnel, as defined by Section 419.021, Government | ||
| Code, regardless of whether the health care services are provided | ||
| in the manner described by Subsection (a)(3). | ||
| SECTION 2. Section 1305.101(a), Insurance Code, is amended | ||
| to read as follows: | ||
| (a) Except for emergencies and out-of-network referrals and | ||
| subject to Section 1305.006(b), a network shall provide or arrange | ||
| for health care services only through providers or provider groups | ||
| that are under contract with or are employed by the network. | ||
| SECTION 3. Section 408.027(f), Labor Code, is amended to | ||
| read as follows: | ||
| (f) Any payment made by an insurance carrier under this | ||
| section shall be made: | ||
| (1) 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, including an out-of-network or non-network | ||
| health care service provided to an injured employee in accordance | ||
| with Section 1305.006(b), Insurance Code; or | ||
| (2) 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 4. The changes in law made by this Act apply only to | ||
| health care services provided on or after the effective date of this | ||
| Act in conjunction with a claim for workers' compensation benefits, | ||
| regardless of the date on which the compensable injury that is the | ||
| basis of the claim occurred. | ||
| SECTION 5. This Act takes effect September 1, 2011. | ||
