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You Need to Know UpdatesCurrent update Network Expansion Approved The Texas Department of Insurance has approved another expansion of Texas Mutual Insurance Company’s Texas Star NetworkSM option. With the expansion, the network will be available to approximately 95 percent of the company’s policyholders. Texas Mutual Insurance Company will begin to offer the workers’ compensation health care network option to policyholders in the additional areas in the next few weeks. Policyholders who are eligible for and choose this option have access to occupational health care providers and case management services that help injured workers get well and back on the job. Most also receive a 12 percent annual network premium discount. You can read more about the Texas Star NetworkSM option here. TDI Network Workshop The Texas Department of Insurance is hosting a Workers' Compensation Health Care Network workshop on January 31, 2007. The workshop will be held in the Capitol Auditorium in Austin from 9:00 a.m. to 4:30 p.m. The workshop will cover the following topics:
There is no charge to attend the workshop, although registration is required. Seating is limited to the first 300 respondents. Click here to register. Notice of Ombudsman Services The Office of Injured Employee Counsel (OIEC) recently adopted new Rule 276.5. The rule requires an employer to post notice of the OIEC Ombudsman Program in its personnel office and in the workplace where employees are likely to see the notice. The notice must be posted in English, Spanish and any other language common to employees. Download a copy of the required notice in English and Spanish. Read the text of adopted Rule 276.5. Interim Activity TDI Report on House Bill 7 Implementation The Texas Department of Insurance (TDI) recently released a report titled "The Effects of the 2005 Legislative Reforms on the Affordability and Availability of Workers' Compensation Insurance for Texas Employers." A provision of House Bill 7 requires TDI to issue a report on the reforms by December 1 of each even numbered year. Click here to read the 2006 report. The executive summary begins on page 6. TDI Research and Evaluation Group Releases Research Agenda The Research and Evaluation group at TDI has released its proposed fiscal year 2007 research agenda. Interested stakeholders may submit written comments on the proposed research agenda through January 2, 2007. You can review the proposed agenda and information regarding the criteria used to determine the agenda by clicking here. Public Hearing on Proposed Disability Management Rules The Division of Workers' Compensation's public hearing on proposed disability management rules, noted in our September 6 update, will now be held at 9:30 a.m. on October 5, 2006 at the Texas Department of Insurance Central Office at 333 Guadalupe Street in Austin. Read the press release announcing the hearing. The deadline for providing rule comments has been extended to 5 p.m. on October 5, 2006. Click here to read the proposed rules. The Division of Workers' Compensation (DWC) has proposed a series of new rules relating to disability management, including return to work and treatment guidelines and treatment planning. The proposed rules are intended to improve communication among system participants, improve return to work outcomes and reduce overall system costs. Return to Work Guidelines DWC is proposing adoption of the most current edition of The Medical Disability Advisor, Workplace Guidelines for Disability Duration (MDA). Return to work guidelines establish a framework for communicating expected return to work timeframes and proposed job duty and activity modifications. MDA is published by Presley Reed. Read more about MDA at this link. Treatment Guidelines Treatment guidelines outline the frequency and extent of services presumed to be medically necessary and appropriate for a compensable injury. DWC is proposing adoption of the most current edition of the Official Disability Guidelines – Treatment in Workers’ Comp (ODG), published by Work Loss Data Institute. Read more about ODG's treatment guideline at this link. DWC's Proposed Rules/Comments Click here to read the proposed Disability Management, Return to Work and Treatment Guideline and Treatment Planning rules. Public comments on the proposed rules are due by 5:00 p.m. on October 2, 2006. There will also be a public hearing regarding the proposed rules on October 2 at DWC's office at 7551 Metro Center Drive in Austin. You can submit your comments via email to rulecomments@tdi.state.tx.us or you can complete the online comment form. Workers' Comp Network Expansion Available Texas Mutual Insurance Company has completed the system changes necessary to implement the expansion of its workers' compensation health care network option. Policyholders located in the counties included in the expansion can now take advantage of this option. Policyholders should contact their agent to request a network endorsement. The easiest way for an agent to get an endorsement for an existing Texas Mutual client or an in-network quote for a new-business submission is through the online services available at www.texasmutual.com. You can also view the expanded service area map and read more about the network option. Hospital Fee Guidelines The Division of Workers' Compensation (DWC) is in the early stages of adopting inpatient and outpatient hospital fee guidelines. Based upon the latest data published by DWC, inpatient and outpatient hospital payments account for approximately 27 percent of workers' compensation medical payments. (See page 43 of 54 of DWC's System Data Report, June 2005). As a part of this rule adoption process, DWC has published a pre-proposal draft rule for both inpatient and outpatient facility fees. A stakeholder meeting to solicit informal feedback on these draft proposals has been scheduled for September 14. Click here to read the meeting notice and pre-proposal drafts. Network Expansion Approved The Texas Department of Insurance has approved the expansion of Texas Mutual Insurance Company’s Texas Star NetworkSM option. With the expansion, the network will be available to approximately 85 percent of the company’s policyholders. Texas Mutual will begin to offer the workers’ compensation health care network option to policyholders in the additional areas in the next few weeks. Policyholders who are eligible for and choose this option have access to occupational health care providers and case management services that help injured workers get well and back on the job. Most also receive a 12 percent annual network premium discount. Rule Development Update The Division of Workers' Compensation (Division) continues to develop rules implementing House Bill 7. Information on the latest rulemaking activities is provided below. Thank you for your interest and participation in the workers' compensation system. New Notice of Injured Employee Rights and Responsibilities The Texas Labor Code and Division Rule 120.2 require employers to provide their employees with this notice at the time an injury report is filed with the insurance carrier. Pursuant to House Bill 7, the Public Counsel for the Office of Injured Employee Counsel developed and submitted a new notice to the Texas Department of Insurance and the Division. Division rules will be amended in the near future to require distribution of the new notice. In order to minimize confusion while the rule is being developed, system participants are asked to use the language of the new notice in all communications with injured employees. You can read Commissioner's Bulletin B-0022-06 regarding the topic here. Treating Doctor Examination to Define Compensable Injury Division Updates Texas Department of Insurance Public Outreach Calendar TDI's speaker's bureau also has a series of workers' compensation events scheduled this year. You can download the calendar for speaker's bureau events here. You can also request a TDI speaker for an event by completing the online Speakers Bureau Request form at the above link. Return-to-Work Pilot Program for Small Employers The return-to-work pilot program, created as a result of House Bill 7, allows employers with 2 to 50 employees to apply for reimbursement. The program will pay out up to $100,000 annually. You can read more about the program and download an application for reimbursement here. DWC Strategic Management Plan House Bill 7 required the Commissioner of Workers' Compensation to develop a plan to define how the Texas Department of Insurance, Division of Workers' Compensation (DWC) can best carry out workers' comp reforms and other statutory requirements. The strategic management plan is now available on DWC's website. Workers' Compensation Working Group Scope Expanded Division Public Hearing The Texas Department of Insurance, Division of Workers' Compensation (DWC) has announced another public hearing on rules implementing House Bill 7. This hearing will provide an opportunity for stakeholders to share their comments and suggestions on proposed rules governing benefit review conferences and interlocutory order requests. The public hearing will be held on Wednesday, May 10, 2006 at 2:00 p.m. in the Tippy Foster Room of the DWC central office located at 7551 Metro Center Drive, Suite 100, Austin, Texas, 78744-1609. Click here to read DWC's notice of public hearing and the rule proposals. Network Option Certified Texas Mutual Insurance Company announced today that the Texas Department of Insurance certified its Texas Star NetworkSM option on March 29. The company will begin offering the network option to eligible policyholders with operations in network service areas on April 3. The Texas Star NetworkSM is the first workers' compensation health care network certified by the Texas Department of Insurance. You can read more at the following links
Division Public Hearing The Texas Department of Insurance, Division of Workers' Compensation (DWC) will hold a public hearing on Thursday, March 30, 2006 at 9:30 a.m. in the Tippy Foster Room of the DWC's central office located at 7551 Metro Center Drive in Austin. DWC will hear testimony on new, amended, and repealed rules that were published in the Texas Register on February 3, 2006. Although the comment period for these rules closed on March 6, 2006, additional comments will be accepted at the hearing. Proposed Rules
Stakeholder Meeting As a reminder, DWC will also hold a stakeholder meeting on March 22, 2006 to discuss pre-proposal draft rules regarding disability management, treatment guidelines, treatment planning, and return-to-work guidelines. Pre-Proposal Draft Rules Disability Management Pre-Proposal Draft Rules Published The Texas Department of Insurance, Division of Workers' Compensation (DWC) will hold a stakeholder meeting on March 22, 2006 to discuss pre-proposal draft rules regarding disability management, treatment guidelines, treatment planning, and return-to-work guidelines. The meeting will be held at 9:30 a.m. at the DWC office at 7551 Metro Center Drive in Austin. If you are unable to attend the meeting but you would like to provide written feedback, please send comments to InformalRuleComments@tdi.state.tx.us. Click the below links to read the pre-proposal draft rules: Medical Dispute Resolution Pre-Proposal Draft Rules The Texas Department of Insurance, Division of Workers' Compensation will hold a stakeholder meeting on March 9, 2006 to discuss pre-proposal draft rules regarding medical dispute resolution. The meeting will be held at 1:00 p.m. at the Texas Department of Insurance's Hobby Building office (333 Guadalupe Street, Austin). You can read the pre-proposal draft rules here. This stakeholder meeting will be held in conjunction with the Network Informal Working Group. The Working Group was created to be a forum for input and counsel to the Texas Department of Insurance as workers´ compensation networks are implemented. You can read more about the Network Informal Working Group here. Division of Workers' Compensation Update HB 7 Rule Update DWC recently proposed several new, amended and repealed rules. Comments on the proposals are due in March. Click here to read the proposals and/or submit comments. New Link for Coverage and Doctor Information If you or your employees use the TXCOMP system to find a doctor on the approved doctor list or look up coverage information, please note that the Web address has changed. Click here for the new TXCOMP link. New DWC Organizational Structure Announced DWC Commissioner Albert Betts has realigned the organizational structure of DWC to better serve its customers. The new structure aligns the functions of DWC into four program areas and consolidates the Texas Department of Insurance and DWC's fraud and legal enforcement functions. Commissioner Betts' press release on the realignment is available here. Return-to-Work Pilot Commissioner Betts has also signed a rule to create a Return-to-Work pilot program for small employers. This program allows employers with 2 to 50 employees to file an application to be reimbursed for expenses to bring their employees back to work to perform modified or alternate work within doctor-imposed work restrictions. The pilot project will reimburse up to $2,500 per employer for qualified expenses. The total expenses of the program are not to exceed $100,000 annually. A press release on the program is available here. January 10 Stakeholder Meeting The Texas Department of Insurance Division of Workers' Compensation will hold a stakeholder meeting on January 10, 2006 to discuss permanent rules regarding billing and reimbursement, preauthorization, and requesting interlocutory orders. The meeting will be held at 9:30 a.m. in Room 100 of the Workers' Compensation Division at 7551 Metro Center Drive in Austin. If you are unable to attend the meeting but you would like to provide written feedback, please send comments to InformalRuleComments@tdi.state.tx.us by 5 p.m. on January 13. Further details on the meeting can be found at the following links: Pre-proposal draft of permanent billing and reimbursement rules Pre-proposal draft of permanent preauthorization rules Pre-proposal draft of requesting interlocutory orders rule TDI Adopts Health Care Network Rules The Texas Department of Insurance (TDI) has adopted rules relating to the implementation of workers' compensation health care networks. Networks may apply to TDI for certification beginning in January 2006. TDI will have 60 days to review each completed application. The adopted rules, as well as TDI's responses to formal public comments, are available on TDI's website in html and pdf (326 pages) format. Strategic Management Plan The Texas Department of Insurance Division of Workers' Compensation will hold a stakeholder meeting on November 14, 2005 to solicit ideas regarding a strategic management plan. The meeting will be held at 10:30 a.m. in Room 1.107 of the Workers' Compensation Division at 7551 Metro Center Drive in Austin. The strategic management plan will discuss how the Division will evaluate and analyze its effectiveness in implementing the statutory goals of House Bill 7, particularly those established to encourage the safe and timely return of injured employees to productive work. The plan is scheduled for completion and release to the public by January 31, 2006. If you are unable to attend the scheduled meeting but you would like to provide written feedback, please send comments to Chris Cook at Chris.cook@tdi.state.tx.us. Further information about the meeting and strategic management plan can be found on the Division's website
Division Stakeholder Meeting and Research Agenda November 8, 2005 Stakeholder Meeting The Division of Workers' Compensation has released an agenda for next Tuesday's Stakeholder meeting. The meeting will be held on November 8th at 9:30 a.m. at the Division of Workers' Compensation, 7551 Metro Center Dr., Ste. 100, Tippy Foster Room. A link to the draft rules that will be discussed on November 8th can be found here. Proposed Research Agenda The Texas Department of Insurance has published a proposed set of research projects in accordance with House Bill 7 requirements. The proposed research projects include network report cards, an injured worker survey and an analysis of return-to work-outcomes. A copy of the proposed research agenda is available here here. Comments must be submitted to the Texas Department of Insurance no later than 5:00 p.m. on November 25, 2005. Any questions about the draft research agenda can be sent to Amy Lee. Division Rulemaking Update Pre-Proposal Draft Rules The Division of Workers' Compensation (DWC) has published more pre-proposal draft rules relating to House Bill 7 implementation. The topics currently under consideration are:
The pre-proposal draft rules can be found here. Send comments on the pre-proposal drafts to InformalRuleComments@tdi.state.tx.us. Stakeholder Meeting DWC will hold a stakeholder meeting on the pre-proposal drafts on November 8. The time and location has not been announced. Check the "What's New" page on DWC's website for updated information. Disability Management DWC has also published a discussion document on disability management. The discussion document contains questions for stakeholders regarding the disability management process. DWC is currently accepting comments on these questions. The discussion document can be found here. Division Announces Rulemaking Priorities The Division of Workers' Compensation (DWC) has published a document containing rulemaking priorities. DWC assigned highest rulemaking priority to the following types of rules:
A working prioritization of rule development activity can be found here. DWC has published pre-proposal drafts of rules relating to preauthorization, medical billing, and a return-to-work pilot program. The pre-proposal draft rules can be found here. DWC will hold a stakeholder meeting on the pre-proposal drafts at 9:30 a.m. on October 25, 2005. The meeting will be held at DWC's office at 7551 Metro Center Drive, Suite 100, Austin, TX, 78744. Written comments on the pre-proposal drafts can also be submitted to DWC on or before October 24. Workers' Comp Commissioner Named On September 1, Governor Rick Perry named Albert Betts Jr. commissioner of the Division of Workers' Compensation at the Texas Department of Insurance. Commissioner Betts' term expires February 1, 2007. Commissioner Betts currently serves as chief of staff and senior associate commissioner of operations at the Texas Department of Insurance. He previously served as general counsel for the State Office of Risk Management, assistant general counsel for the Texas Workers’ Compensation Commission, and assistant attorney general for the Office of the Attorney General. Also, the Texas Department of Insurance has established a new home page for the Division of Workers' Compensation effective September 1. Click here to visit the new page. Proposed Network Regulations The Texas Department of Insurance (TDI) has formally proposed rules relating to the implementation of workers' compensation health care networks. The proposed rules will be published in the September 2, 2005 issue of the Texas Register. Comments on these rules are due by October 3, 2005. Send your comments to: TDI requests that an additional copy of the comments be simultaneously submitted to: TDI will hold a public hearing on the rules on Thursday, October 6, 2005, at 9:30 a.m. in Room E1.004 of the State Capitol Building. Click here to read the proposed rules. House Bill 7 Rules The Texas Department of Insurance (TDI)/Texas Workers' Compensation Commission transition team is soliciting input from stakeholders on rule development priorities relating to House Bill 7. For more information, click here. The HB 7 Rule Priority Options document lists rules by subject. Stakeholders can use the document to submit feedback about rule priorities, including proper sequencing of the rule proposals. TDI would also like to know if stakeholders have rule proposals to be added to the list, or if certain rules should be paired together to ensure consistency. TDI requests that stakeholders provide their recommendations by September 2. Send your recommendations via email to WCRules@tdi.state.tx.us. Texas Department of Insurance Bulletins on House Bill 7 The Texas Department of Insurance (TDI) has released several Commissioner's Bulletins relating to House Bill 7 and the transfer of the administration of the workers' compensation system from the Texas Workers' Compensation Commission to TDI. COMMISSIONER'S BULLETIN NO. B-0033-05 - This bulletin provides a general notice regarding the transfer of functions and also notes that the Division will promulgate, amend, and repeal rules as appropriate to reflect the changes made to the workers’ compensation system during the 79th Regular Session. In some instances, rulemaking may not be completed until after the statutory changes become effective. COMMISSIONER'S BULLETIN NO. B-0034-05 - This bulletin notes enforcement changes effective September 1, 2005. COMMISSIONER'S BULLETIN NO. B-0035-05 - This bulletin deals with medical dispute decisions and notes that an appeal of a medical dispute resolution decision that is not pending on or before August 31, 2005 for a hearing at SOAH is not entitled to a SOAH hearing. COMMISSIONER'S BULLETIN NO. B-0036-05 - This bulletin provides information regarding modifications to letters, forms and websites that reference the Texas Workers' Compensation Commission. COMMISSIONER'S BULLETIN NO. B-0037-05 - This bulletin deals with changes to timeframes for medical billing and payment effective September 1, 2005. COMMISSIONER'S BULLETIN NO. B-0038-05 - This bulletin announces the elimination of the Field Safety Representative, Hazardous Employer, and Drug Free Workplace programs. Texas Department of Insurance Activity Transition The Texas Department of Insurance (TDI) created a Web page to provide information related to the transition of workers' compensation system administration from the Texas Workers' Compensation Commission to TDI. Network Developments TDI has scheduled a stakeholder meeting on July 12, 2005 from 1 p.m. to 3 p.m. for persons interested in providing input on workers' compensation network regulations. If you are interested in providing comments but cannot attend the meeting, email your comments to WCNet@tdi.state.tx.us by July 20, 2005. Visit our House Bill 7 Resource Page to learn more about the legislation's effect on the workers' compensation system, including new provisions relating to the establishment of workers' compensation health care networks. Insurance Commissioner Named Governor Rick Perry named Mike Geeslin the new commissioner for the Texas Department of Insurance (TDI). Perry said Geeslin will "play an integral role in overseeing major reforms to our workers' compensation system." Geeslin has served as TDI's deputy commissioner for policy since January 2003. His appointment is subject to Senate confirmation during the next legislative session, and his term will expire on February 1, 2007. Texas Mutual® is a registered service mark of Texas Mutual Insurance Company. |
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