MPM, MSH C.S.H.B. 1192 77(R) BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1192 By: Brimer Business & Industry 3/19/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Current law entitles state employees to receive medical benefits for injuries sustained while on the job. Except in an emergency, employees are required to seek medical treatment from a list of doctors approved by the Texas Workers' Compensation Commission (TWCC). The list includes each doctor licensed in this state on January 1, 1993, except those who have been removed by TWCC from the lists for certain questionable practices. C.S.H.B. 1192 creates a pilot program that contracts with a network of doctors known as gateway doctors to provide medical treatment to injured state employees to evaluate the effectiveness of the use of gateway doctors in reducing costs incurred by the state and in providing better treatment to injured workers. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the risk management board and the board of directors of the Research and Oversight Council on Workers' Compensation in SECTION 1 (Section 412.065, Labor Code) and SECTION 4 of this bill. ANALYSIS C.S.H.B. 1192 amends the Labor Code to require the State Office of Risk Management (office) and the Research and Oversight Council on Workers' Compensation (council) to jointly develop and implement a pilot program (program) to provide medical benefits to certain state employees who sustain compensable injuries through the use of one or more health care delivery networks under which health care is provided by specific health care doctors or chiropractors under contract (gateway doctors). The bill requires the office and the council to jointly select a limited number of state agencies to participate in the program and provides that the selected agencies are required to participate. The bill requires the office and the council to design the program in a manner that: _provides state employees and the management of participating state agencies the opportunity for input regarding the health care practitioners and providers used by the program and returnto-work coordination appropriate for the program; _enhances the delivery of medical benefits by providing better health care and faster access to that care; _allows employees access to networks of physicians and chiropractors that are effectively monitored for appropriate credentials, provision of quality care, enhancement of the return to work of injured employees, and cost-effective outcomes; and _enables the state to determine whether extension of the use of a health care delivery network and gateway doctors would decrease direct costs associated with the operation of the state employee workers' compensation program. The bill requires the office and the council to submit a written report to the legislature concerning the effectiveness of the program in reducing state medical benefits costs no later than February 1 of each oddnumbered year. The bill authorizes the risk management board (board) and the board of directors of the council to adopt rules and enter into contracts as necessary or appropriate to implement the program not later than December 1, 2001. The bill exempts employees participating in the program from provisions requiring them to receive medical treatment, as it relates to workers' compensation benefits, from a doctor chosen from a list of doctors approved by the Texas Workers' Compensation Commission. The bill provides that employees of agencies participating in the program are required to use the services of a gateway doctor or specialist participating in the program to receive medical benefits. The bill entitles an employee to select an initial treating doctor from the list of gateway doctors. The bill requires the board to provide employees of participating agencies with a list of participating gateway doctors or specialists. EFFECTIVE DATE September 1, 2001, and applies only to a claim for workers' compensation benefits based on a compensable injury that occurs on or after January 1, 2002. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1192 differs from the original by including a chiropractor in the definition of gateway doctor. The substitute specifies that services to state employees under the gateway doctor pilot program (pilot program) are delivered through one or more health care delivery networks rather than a single network. The substitute modifies the manner in which the State Office of Risk Management and the Research and Oversight Council on Workers' Compensation are required to develop the pilot program to include the provisions that the program provide state employees and the management of participating state agencies the opportunity for certain input regarding the pilot program and allow employees access to networks of physicians and chiropractors that are effectively monitored.