| TEXAS WORKERS COMPENSATION COLLECTION PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
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February 21, 2012: Texas News: Rulebook
Supplement 2012-02
February 13, 2012: Texas News: Adoption:
Amendments to 28 TAC Chapter 180 Regarding
the Monitoring and Enforcement Authority of
the Division of Workers’ Compensation
January 04, 2012: Texas News: New 28 TAC
§127.130(b) Regarding Designated Doctor’s
Qualification Criteria
December 28, 2011: Texas News: TDI-DWC
Hosts Educational Sessions on Overview
of Two New Rules
December 22, 2011: Texas News: TDI-DWC
Hosts Educational Sessions on Overview
of Two New Rules
December 22, 2011: Texas News: New 28 TAC
§127.130(b) Regarding Designated Doctor’s
Qualification Criteria
December 13, 2011: Texas News:
Input Needed for Development of Utilization
Review Agent Plan-Based Audit //Input Needed
for Development of the Medical
Quality Review CY 2012 Annual Audit Plan
//Free OSHA 10-Hour Construction Course
Offered in Spanish in El Paso on January 17 and
18
December 07, 2011:Texas News:
Informal Draft of Rules Relating to Medical
Dispute Resolution //
November 15, 2011: Texas: News:
Revised DWC Form-045, Request to Schedule,
Reschedule, or Cancel a Benefit Review
Conference (BRC)
November 15, 2011: Texas: News:
Adopted Amendments: 28 TAC ยง141.2 and
ยง141.3 Regarding Canceling or Rescheduling a
Benefit Review Conference and Failure to Atte
October 25, 2011: Texas: News:
Informal Draft of Rules Relating to Designated
Doctor Procedures and Requirements
October 25, 2011: Texas: News::
The Texas Workers’ Compensation Rulebook
Supplement 2011-04 containing rules adopted
by the Commissioner of Workers’
Compensation is available online
October 20, 2011: Texas: News:
Today, the Texas Department of Insurance,
Division of Workers’ Compensation (TDI-
DWC) released the results of the 2011 Health
Care Provider PBO assessment. For 2011,
health care providers were assessed on their
performance in one of three categories:
October 11, 2011: News:
The Texas Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
accepting public comment on the proposed
amendments to 28 Texas Administrative Code
(TAC) §§180.1, 180.3, 180.5, and 180.27 and
proposed new rules 28 TAC §§180.4, 180.9,
and 180.10. This proposal relates to monitoring
and enforcement activities conducted by the
TDI-DWC, specifically compliance audits, on-
site visits, proposals for decision, informal
dispositions by default, and ex parte emergency
cease and desist orders. These proposed
amendments and new rules are primarily
intended to implement recent statutory
amendments in House Bill 2605 by the 82nd
Legislature, Regular Session,
effective September 1, 2011, that affect the TDI-
DWC’s monitoring and enforcement authority.
October 11, 2011: News:
El Paso Field Office of the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
hosting a brown bag educational session entitled
Pharmacy Closed Formulary on Tuesday,
October 18, 2011
The Weslaco Field Office of the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
hosting a brown bag educational session entitled
Pharmacy Closed Formulary on Tuesday,
October 25, 201
The Amarillo Field Office of the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
hosting a brown bag educational session entitled
Pharmacy Closed Formulary on Tuesday,
October 25, 2011
October 03, 2011: News:
Effective November 1, 2011, the Victoria Field
Office of the Texas Department of Insurance,
Division of Workers’ Compensation (TDI-
DWC) will close permanently.
September 28, 2011
Work-Related Fatalities Decreased in Texas in
2010
AUSTIN, TX - Texas recorded a preliminary
total of 456 work-related fatalities in 2010, a 5
percent decrease compared to the revised 2009
total of 482 fatalities. Nationally, there were a
preliminary total of 4,547 fatal work injuries in
2010, about the same as the final revised count
of 4,551 in 2009, according to the most recently
available data released on August 25, 2011, by
the U.S. Department of Labor, Bureau of Labor
Statistics (BLS), Census of Fatal Occupational
Injuries (CFOI).
September 21, 2011:News:
Division of Workers' Compensation Announces
August Enforcement Actions
September 19, 2011:TDI-DWC Finalized
Treating Doctors – Lumbar Spinal Fusions Plan-
Based Audit
Workers' Compensation Resources for Health
Care Providers
Billing and Reimbursement
Comp Connection for Health Care Providers
Complaints
Designated Doctor Resources and Information
Dispute Resolution
Supplement 2012-02
February 13, 2012: Texas News: Adoption:
Amendments to 28 TAC Chapter 180 Regarding
the Monitoring and Enforcement Authority of
the Division of Workers’ Compensation
January 04, 2012: Texas News: New 28 TAC
§127.130(b) Regarding Designated Doctor’s
Qualification Criteria
December 28, 2011: Texas News: TDI-DWC
Hosts Educational Sessions on Overview
of Two New Rules
December 22, 2011: Texas News: TDI-DWC
Hosts Educational Sessions on Overview
of Two New Rules
December 22, 2011: Texas News: New 28 TAC
§127.130(b) Regarding Designated Doctor’s
Qualification Criteria
December 13, 2011: Texas News:
Input Needed for Development of Utilization
Review Agent Plan-Based Audit //Input Needed
for Development of the Medical
Quality Review CY 2012 Annual Audit Plan
//Free OSHA 10-Hour Construction Course
Offered in Spanish in El Paso on January 17 and
18
December 07, 2011:Texas News:
Informal Draft of Rules Relating to Medical
Dispute Resolution //
November 15, 2011: Texas: News:
Revised DWC Form-045, Request to Schedule,
Reschedule, or Cancel a Benefit Review
Conference (BRC)
November 15, 2011: Texas: News:
Adopted Amendments: 28 TAC ยง141.2 and
ยง141.3 Regarding Canceling or Rescheduling a
Benefit Review Conference and Failure to Atte
October 25, 2011: Texas: News:
Informal Draft of Rules Relating to Designated
Doctor Procedures and Requirements
October 25, 2011: Texas: News::
The Texas Workers’ Compensation Rulebook
Supplement 2011-04 containing rules adopted
by the Commissioner of Workers’
Compensation is available online
October 20, 2011: Texas: News:
Today, the Texas Department of Insurance,
Division of Workers’ Compensation (TDI-
DWC) released the results of the 2011 Health
Care Provider PBO assessment. For 2011,
health care providers were assessed on their
performance in one of three categories:
October 11, 2011: News:
The Texas Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
accepting public comment on the proposed
amendments to 28 Texas Administrative Code
(TAC) §§180.1, 180.3, 180.5, and 180.27 and
proposed new rules 28 TAC §§180.4, 180.9,
and 180.10. This proposal relates to monitoring
and enforcement activities conducted by the
TDI-DWC, specifically compliance audits, on-
site visits, proposals for decision, informal
dispositions by default, and ex parte emergency
cease and desist orders. These proposed
amendments and new rules are primarily
intended to implement recent statutory
amendments in House Bill 2605 by the 82nd
Legislature, Regular Session,
effective September 1, 2011, that affect the TDI-
DWC’s monitoring and enforcement authority.
October 11, 2011: News:
El Paso Field Office of the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
hosting a brown bag educational session entitled
Pharmacy Closed Formulary on Tuesday,
October 18, 2011
The Weslaco Field Office of the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
hosting a brown bag educational session entitled
Pharmacy Closed Formulary on Tuesday,
October 25, 201
The Amarillo Field Office of the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is
hosting a brown bag educational session entitled
Pharmacy Closed Formulary on Tuesday,
October 25, 2011
October 03, 2011: News:
Effective November 1, 2011, the Victoria Field
Office of the Texas Department of Insurance,
Division of Workers’ Compensation (TDI-
DWC) will close permanently.
September 28, 2011
Work-Related Fatalities Decreased in Texas in
2010
AUSTIN, TX - Texas recorded a preliminary
total of 456 work-related fatalities in 2010, a 5
percent decrease compared to the revised 2009
total of 482 fatalities. Nationally, there were a
preliminary total of 4,547 fatal work injuries in
2010, about the same as the final revised count
of 4,551 in 2009, according to the most recently
available data released on August 25, 2011, by
the U.S. Department of Labor, Bureau of Labor
Statistics (BLS), Census of Fatal Occupational
Injuries (CFOI).
September 21, 2011:News:
Division of Workers' Compensation Announces
August Enforcement Actions
September 19, 2011:TDI-DWC Finalized
Treating Doctors – Lumbar Spinal Fusions Plan-
Based Audit
Workers' Compensation Resources for Health
Care Providers
Billing and Reimbursement
Comp Connection for Health Care Providers
Complaints
Designated Doctor Resources and Information
Dispute Resolution
- Medical Control
If the employer is enrolled in a Certified Health Care Network (HCN), the injured employee
selects the initial "treating doctor" from the HCN; or may request to treat with his/her existing
HMO primary treating physician under certain circumstances. The "treating doctor" is
responsible for the injured employee's healthcare for an injury, as well as all referrals for
specialty care, and may come from one of the following groups: Family Practice, General
Practice, Internal Medicine, Physical Medicine and Rehabilitation, Occupational Medicine, or
Occupational Medicine physicians who are working in Occupational Clinics or Urgent Care
Centers. If the employer is not enrolled in the HCN, the injured employee has the right to
choose his/her treating provider. Any request to change providers must be approved by the local
Division of Workers' Compensation office handling the jurisdiction. The treating provider may
refer the patient to a specialist without permission or approval from the Division or the
insurance carrier. The employee may select his/her own pharmacy or select a pharmacy from the
Express Scripts pharmacy network. Emergency medical care does not require preapproval and
should be secured at the nearest location.
SB 130
Silent PPOs: SB 130 by Nelson prohibits the misrepresentation of discounts by insurers to
hospitals and physicians. A practice referred to as "silent PPOs" takes place when an insurer
states that they are entitled to a discount they knowingly are not entitled to and has no ties with
the original contract of a legitimate PPO. This practice hurts hospitals, physicians, and most
importantly the consumer of these health care service. This bill would hold these individuals
accountable, finding them in violation of the law by committing an unfair act or deceptive
practice.
§ 1301.056 of the Insurance Code addresses the issues of silent PPOs. It specifically states that
insurance companies are barred from paying physicians, hospitals, or other healthcare providers
at a discounted rate unless the company has entered into a contract with that doctor, institution,
or healthcare provider. The healthcare provider (whether an individual or an institution) must
have voluntarily entered into the contract and specifically agreed to the terms of the contract.
The legislation goes on to state that a preferred provider contract may not be sold, transferred, or
leased to another party unless all parties to the contract give their consent. Any person or
corporation who violates the provisions contained in this section will be subject to
"administrative penalties" for making what is referred to as an "unfair claim
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