The Texas Department of Insurance, Division of Workers' Compensation ("DWC") is accepting public comments on proposed new rules for 28 Texas Administrative Code Section 134.150 and Section 134.155 to implement Senate Bill ("SB") 935, 86th Legislature (2019).
SB 935 requires the DWC to adopt rules necessary to implement Labor Code Section 413.0112 no later than December 1, 2019. The rules will establish requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility ("FMTF"), as well as a separate medical dispute resolution process to resolve charges billed directly to an injured employee by an FMTF.
The change in law made by SB 935 applies to health care services provided to an injured employee on or after January 1, 2020, regardless of the date of injury.
Rule 134.150
- Establishes applicability of rules in subsections (a)-(b).
- Clarifies in subsection (c)-(d) bill processing and handling requirements.
- Clarifies in subsection (e) that an insurance carrier may only deny a medical bill based on medical necessity, compensability, extent, or liability.
- Creates in subsection (f) obligations for medical bill reporting by an insurance carrier requiring submission of the first bill received from an FMTF.
- Clarifies in subsection (g) that unreported bills are subject to a request for information under Rule 102.9.
Rule 134.155
- Provides in subsection (a)(1) that disputes for medical necessity will be handled under Rule 133.308, that an injured employee may initiate a dispute, and that the insurance carrier will be responsible for all independent review organization fees.
- Provides in subsection (a)(2) that all other disputes will be handled under the existing process for benefit review conferences.
- Notes in subsection (c) that a first responder may request expedited dispute resolution.
The proposed rules will be published in the August 30, 2019, issue of the Texas Register and will be available at https://www.sos.state.tx.us/texreg/index.shtml once published. A courtesy copy will also be available on the TDI website at www.tdi.texas.gov/wc/rules/2019rules.html.
The DWC will host a public hearing on these rules on Monday, September 16, 2019, at 10 a.m. at the DWC central office located at 7551 Metro Center Drive, Suite 100, in Austin.
To be considered, comments must be received by 5 p.m., Central time, on Monday, September 30, 2019.
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].