28 TAC §126.8
The Texas Workers' Compensation Commission (the commission)
proposes amendments to §126.8, concerning the Commission Approved Doctor
List. These amendments are being proposed to correct and update references
to rules and laws.
In 1993, §126.8 was proposed to establish criteria, in addition to
those criteria specified in Texas Civil Statutes, Article (8308-4.63) for
the addition of doctors and for the removal of doctors from the commission's
approved doctor list. This section was required by Texas Civil Statutes, Article
8308-4.63 (now the Texas Labor Code §408.023). The duty to conduct hearings
under the Administrative Procedure Act was first located in the commission's
Division of Hearings. In 1995, the Texas Legislature moved this duty to the
State Office Administrative Hearings effective January 1, 1996. The commission
adopted the rules in 28 T.A.C. Chapters 148 and 149 to implement this change.
For this reason references to the Chapter 145 rules should be replaced with
references to the rules in Chapter 148, relating to Hearings Conducted by
the State Office of Administrative Hearings.
Also in 1993, the Texas Legislature incorporated the Texas Workers' Compensation
Act into the Texas Labor Code, Title 5, Subtitle A. Reference to Articles
8308-4.63 corresponds now to §408.023 of the Texas Labor Code (relating
to Contested Cases: General Rights and Procedures, Opportunity for Hearing
and Participation); therefore, these references should be revised accordingly.
In addition, the reference to Article 8308-2.09 (f), relating to the powers
and duties of the commission corresponds to §402.072 of the Texas Labor
Code.
The Texas Legislature incorporated the Administrative Procedure and Texas
Register Act into the Texas Government Code in 1993 as well. Therefore, the
reference to Article 6252-13a (the Administrative Procedure and Texas Register
Act) should be changed to §2001.051 of the Texas Government Code.
Yvonne Williams, Manager of APA, Division of Hearings has determined that
for the first five year period the proposed amendment is in effect, there
will be no fiscal implications for state or local governments because the
amendments merely change references to reflect the law and rules currently
in effect.
Local government and state government as covered regulated entities will
be impacted in the same manner as described later in this preamble for persons
required to comply with the rule as proposed.
Ms. Williams has also determined that for each year of the first five years
after the rule is amended as proposed, the public benefits anticipated as
a result of the amendment will be the elimination of outdated references.
There will be no anticipated economic costs to persons who are affected by
the amendment of the rules as proposed.
Because the amendments merely change references to reflect the law and
rules currently in effect, there will be no costs of compliance for small
businesses. There will be no adverse economic impact on small businesses or
micro- businesses. There will be no difference in the cost of compliance for
small businesses or micro-businesses as compared to large businesses.
Comments on the proposal or requests for public hearing must be received
by 5:00 p.m., April 9, 2001. You may comment via the Internet by accessing
the commission's website at www.twcc.state.tx.us and then clicking on "Proposed
Rules." This medium for commenting will help you organize your comments by
rule chapter. You may also comment by emailing your comments to RuleComments@twcc.state.tx.us
or by mailing or delivering your comments to Sue Cutler at the Office of Legal
Services, Mailstop #4-D, Texas Workers' Compensation Commission, Southfield
Building, 4000 South IH-35, Austin, Texas 78704- 7491.
Commenters are requested to clearly identify by number the specific rule
and paragraph commented upon. The commission may not be able to respond to
comments that cannot be linked to a particular proposed rule. Along with your
comment, it is suggested that you include the reasoning for the comment in
order for commission staff to fully evaluate your recommendations.
Based upon various considerations, including comments received and the
staff's or commissioners' review of those comments, or based upon the commissioners'
action at the public meeting, the rule as adopted may be revised from the
rule as proposed in whole or in part. Persons in support of the rule as proposed,
in whole or in part, may wish to comment to that effect.
This proposed amendment to §126.8 affects the following
statutes: The Texas Labor Code §402.061, which authorizes the commission
to adopt rules necessary to administer the Act, the Texas Labor Code §402.073,
relating to the Cooperation with the State Office of Administrative Hearings,
the Texas Labor Code §408.023, relating to the List of Approved Doctors,
and the Texas Government Code §2000.01, relating to hearings before the
State Office of Administrative Hearings.
The amended rule is proposed under the Texas Labor Code, §402.061,
which authorizes the commission to adopt rules necessary to administer the
Act, the Texas Labor Code §402.073, relating to the Cooperation with
the State Office of Administrative Hearings, the Texas Labor Code §408.023,
relating to the List of Approved Doctors, and the Texas Government Code §2000.01,
relating to hearings before the State Office of Administrative Hearings.
The amended rule is proposed under the Texas Labor Code, §§402.061,
402.073, 408.023, and the Texas Government Code §2000.01.
§126.8.Commission Approved Doctor List.
(a)
On or after January 1, 1993, except in emergency situations,
injured employees must receive medical treatment from a doctor on the commission
approved doctor list (the list). This list initially includes all doctors
licensed in Texas on or after January 1, 1993, and doctors licensed in other
jurisdictions who have been added to the list by the commission.
(b)
Doctors licensed in other jurisdictions may ask to be added
to the list by submitting a written request containing information prescribed
by the commission. Unless the doctor has been deleted from the list by the
commission, a carrier shall not withhold reimbursement to doctors licensed
in other jurisdictions when the only reason for nonpayment is that the doctor
is not presently on the list.
(c)
Each month, the division of medical review (the division)
will provide insurance carriers, through designated Austin representatives,
with the names of:
(1)
doctors deleted from the list;
(2)
doctors reinstated to the list; and
(3)
doctors added to the list from other jurisdictions.
(d)
Doctors may be deleted from the list for the following:
(1)
sanctions imposed by the commission against the doctor
for violations of the Act, commission rules, or commission orders;
(2)
sanctions by Medicare or Medicaid for substandard medical
care, overcharging, or overutilization of medical services;
(3)
substantial differences between the doctor's charges, fees,
diagnoses, or treatments and those the commission finds to be fair and reasonable;
(4)
revocation or suspension of a doctor's license by the
appropriate licensing authority;
(5)
limitations or restrictions on the professional license
or disciplinary actions taken by the appropriate licensing authority;
(6)
criminal conviction which indicates an unwillingness or
inability to provide quality treatment or to abide by the Act, commission
rules, or commission orders; or
(7)
other activities which warrant deletion.
(e)
The division shall notify a doctor by certified mail, return
receipt requested, of the division's intent to recommend to the commissioners
that the doctor be deleted from the list. Within 20 days after receiving the
notice, a doctor may request a hearing as provided by
Section 408.023
of the Texas Labor Code (relating to List of Approved Doctors), §2001.051
of the Texas Government Code (relating to Opportunity for Hearing and Participation),
and Chapter 148 of this title (relating to Hearings Conducted by the State
Office of Administrative Hearings).
[
Texas Civil Statutes, Article
8308- 4.63, and Article 6252-13a (the Administrative Procedure and Texas Register
Act), and §145.3 of this title (relating to Requesting a Hearing).
]
If a request for hearing is received, the Commission shall hold a hearing
as provided in Chapter
148
[
145
] of this title [
(related to Dispute Resolution - Hearings Under the Administrative Procedure
and Texas Register Act)
]. If no response for hearing is filed within
the time allowed, the division's recommendation will be reviewed by the Commissioners
at a public meeting and a decision made to either delete or maintain the doctor
on the list.
(f)
As described in
Texas Labor Code §402.072 (relating
to Sanctions) and Chapter 148 of this title,
[
Texas Civil Statutes,
Article 8308- 2.09(f) and §145.24 of this title (relating to Special
Provisions for Imposing Sanctions Pursuant to the Act, §2.09(f)),
]
only the Commissioners may delete a doctor from the list. The commission shall
notify the doctor by issuing an order of deletion which describes the effects
of the deletion on the doctor and the doctor's patients subject to workers'
compensation. This order shall be delivered to the doctor by certified mail,
return receipt requested, with a copy to the licensing authority and copies
to those injured employees the commission is aware are being treated by that
doctor. After receipt, the doctor shall also inform any injured employees,
seeking treatment under the Act, of the doctor's deletion from the list and
that the injured employee may not, except in an emergency, receive care. Failure
to inform the injured employees in the form and format prescribed by the commission
may subject the doctor to administrative penalties of up to $10,000 and other
sanctions as provided by the Act.
(g)
To be reinstated, a doctor deleted from the list must apply
for reinstatement in the form and manner prescribed by the commission through
the Medical Review Division in Austin. If, in the division's opinion, the
doctor has all the appropriate unrestricted licenses to practice at the time
of reinstatement, has overcome the conditions which resulted in deletion,
and should be reinstated, the division shall recommend that the commissioners
reinstate the doctor to the list.
(h)
If, in the division's opinion, the doctor has not met the
requirements for reinstatement, or for other reasons should not be reinstated,
the division shall notify the doctor by certified mail, return receipt requested,
of the division's intent to recommend to the Commissioners that the doctor
not be reinstated to the list. Within 20 days after receiving the notice,
a doctor may request a hearing as provided in subsection (e) of this section.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on February 22, 2001.
TRD-200101092
Susan Cory
General Counsel
Texas Workers' Compensation
Earliest possible date of adoption: April 8, 2001
For further information, please call: (512) 804-4287