TITLE 28.INSURANCE

Part 2. TEXAS WORKERS' COMPENSATION COMMISSION

Chapter 110. REQUIRED NOTICES OF COVERAGE

Subchapter A. CARRIER NOTICES

28 TAC §110.1

The Texas Workers' Compensation Commission (commission) adopts amendments to §110.1 of this title, concerning Requirements for Notifying the Commission of Insurance Coverage, without changes to the proposed text published in the April 4, 2003, issue of the Texas Register (28 TexReg 2880).

As required by the Government Code §2001.033(1), the commission's reasoned justification for this rule is set out in this order which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and the reasons why the commission disagrees with some of the comments and proposals.

Previously, the commission did not address the use of insurance binders by rule, although they are an accepted part of insurance practice as a precursor to issuing a policy. As a result, carriers did not have a way of notifying the commission that a temporary binder agreement between an employer and carrier providing workers' compensation coverage was in effect. This amendment clarifies the issuance of a binder as constituting workers' compensation coverage and provides that the same rules that apply to canceling a policy apply to canceling a binder.

By Advisories 2002-07 and 2002-07B the commission has implemented the electronic reporting of insurance coverage information by commercial insurance carriers through designated data collection agents effective September 1, 2002. The International Association of Industrial Accident Boards and Commissions (IAIABC) Proof of Coverage (POC) Release 2 standard is used as the reporting medium. The commission has received requests from several carriers to report workers' compensation insurance coverage represented by binders using the IAIABC POC binder transaction to meet the reporting requirements of §110.1. The amended section more clearly states how binders are used in the Texas workers' compensation system and clarify the requirements for reporting workers' compensation insurance coverage to the commission.

Adopted §110.1 adds new subsection (a), which clarifies that a binder constitutes an approved insurance policy as referenced in Texas Labor Code §401.011(44)(A), and new subsection (b), which defines the term, "insurance coverage information" as used in the rule. The amendments re-designate the remaining subsections as (c) through (l) accordingly. Amended subsection (e) clarifies that the requirements of that subsection apply to employers who do not have workers' compensation insurance coverage.

Language is added to subsection (h)(2), requiring an insurance carrier to notify the commission if it cancels a binder before it issues a policy. Although no changes were proposed or made to subsection (i), it should be noted that the adopted changes to the rule make this subsection applicable to situations in which a binder is canceled prior to the issuance of a policy. That is, workers' compensation insurance coverage, including coverage that becomes effective pursuant to the issuance of a binder, remains in effect until the later of the circumstances enumerated in current subsection (i).

Other amendments were made for clarity and for consistency in terminology.

Comments supporting the proposed amendment to §110.1 were received from the Insurance Council of Texas. Comments opposing the proposed amendments to §110.1 were received from the Texas Association of Responsible Nonsubscribers.

Summaries of the comments and commission responses are as follows:

COMMENT: Commenter stated general support of the rule as proposed as it responded to requests from the insurers to have the commission accept the reporting of workers' compensation insurance coverage as represented by binders using the IAIABC POC binder transaction.

RESPONSE: The commission concurs.

COMMENT: Commenter took exception to the statement in the proposal preamble that the proposed changes benefit all system participants in providing more complete and accurate information regarding the existence of workers' compensation coverage for Texas employers. Commenter did not believe that the proposed changes would benefit nonsubscribing employers.

RESPONSE: The commission disagrees. The amendment does benefit system participants in the way described. Nonsubscribing employers have opted out of the workers' compensation system and are not considered system participants.

COMMENT: Commenter disagreed that the proposed amendment either improves clarity or consistency as it relates to coverage reports provided by nonsubscribing employers, and specifically found that the terminology of "insurance coverage information" in §110.1(e) would be confusing to nonsubscribing employers since many nonsubscribing employers provide various other types of insurance.

RESPONSE: The commission disagrees. The amendments to §110.1(a) clarify the effect of a workers' compensation insurance binder. This clarification is helpful to those who need to confirm workers' compensation coverage. In addition, new subsection (b) defines "insurance coverage information" as information regarding whether or not an employer has workers' compensation insurance coverage and subsection (e) clearly states that it is applicable to employers who do not have workers' compensation insurance coverage. Therefore, this information should not cause confusion regarding other types of insurance coverage.

The amendments are adopted pursuant to Texas Labor Code §401.024, which allows the commission to collect coverage information by electronic transmission; Texas Labor Code §402.042, which authorizes the Executive Director to prescribe the form, manner, and procedure for transmission of information to the commission; Texas Labor Code §402.061, which authorizes the commission to adopt rules necessary to administer the Texas Workers' Compensation Act (Act); Texas Labor Code Chapter 406, Subchapter A, which addresses workers' compensation coverage election and security procedures, including Texas Labor Code §406.006, which requires insurance carriers to report employer coverage and claim administration contact information to the commission; Texas Labor Code §406.008, which requires insurance carriers to report changes they initiate to employer coverage to the commission; and Texas Labor Code §406.009, which requires the commission to collect and maintain coverage information; monitor and enforce the compliance of the timely submission of coverage information and authorizes the commission to adopt rules as necessary to enforce the provisions of Texas Labor Code Chapter 406, Subchapter A.

The amendments are adopted pursuant to Texas Labor Code §§401.024, 402.042, 402.061, Chapter 406, Subchapter A, including, §§406.006, 406.008, and 406.009.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303038

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 804-4287


Chapter 124. CARRIERS: REQUIRED NOTICES AND MODE OF PAYMENT

28 TAC §124.2

The Texas Workers' Compensation Commission (the commission) adopts amendments to §124.2, concerning Carrier Reporting and Notification Requirements, with changes to the proposed text published in the April 4, 2003, issue of the Texas Register (28 TexReg 2882).

As required by the Government Code §2001.033(1), the commission's reasoned justification for this rule is set out in this order, which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and the reasons why the commission disagrees with some of the comments and proposals.

Changes made to the proposed rule are in response to public comment received in writing and are described in the summary of comments and responses section of this preamble.

Changes in the proposed text are found in §124.2(c)(1) and §124.2(n).

In order to properly execute its responsibilities under the Texas Labor Code, the commission must associate reported workers' compensation claims with the coverage information reported by the insurance carrier (as defined in Texas Labor Code §401.011(27)) under §110.1 of this title (related to Requirements for Notifying the Commission of Insurance Coverage). To facilitate this process and allow for its automation, the commission amends §124.2(c)(1) to require that specific items of coverage information (the insurance carrier's Federal Employer Identification Number (FEIN), the employer's policy number and the policy period) be reported by the insurance carrier in conjunction with the information from the Employer's First Report of Injury and that this information be identical with that reported under §110.1 for the employer associated with the claim.

Section 124.2(c)(4) has been amended to require that the items of coverage information specified in §124.2(c)(1) be reported to the commission through a "Change" transaction if they are not available when the First Report of Injury is submitted.

The provisions for reporting the required coverage information are already incorporated in the International Association of Industrial Accident Boards and Commissions (IAIABC) Electronic Data Interface First Report of Injury currently in use by the commission pursuant to subsection (b) of the rule. No changes to the current First Report of Injury record layout are required by the amended rule.

Analysis of the commission's database indicates that of the first reports of injury submitted by EDI, all of them contain the carrier's FEIN (mandatory field), approximately 86 percent contain the policy number, and approximately 70 percent contain the policy period information. However, of the first reports of injury containing the policy number, in only 58 percent of the cases does the policy number match the policy number reported through the coverage reporting system. This rule change emphasizes the importance of consistent reporting of these key data elements which will enable the automated association of claim and coverage information in the commission's new automation system (TXCOMP).

All participants in the workers' compensation system interact with the insurance carrier (as defined in Texas Labor Code §401.011(27)) or the third party representing the insurance carrier for various claim administration functions such as coverage verification, claim adjustment, medical billing and preauthorization. The commission is continuously asked for this contact information but does not currently collect or maintain it in a standardized or accessible form. New §124.2(n) requires each insurance carrier to provide to the commission, through its Austin representative, the contact information for all workers' compensation claim service administration functions performed by the insurance carrier either directly or through third parties. The insurance carrier may provide this information either by creating and maintaining a single World Wide Web (Web) page containing this information and furnishing the Uniform Resource Locator (URL) of that Web page to the commission through its Austin representative or by having the Austin representative make an online submission of the contact information that the commission will make available to the public. This second option represents a change from the rule as proposed, which only provided the Web page option.

The commission envisions that the input of the URL or contact information will be performed by the carrier's Austin representative through their ability to log onto the commission's new information system (TXCOMP) and update specific information on the carrier's data record. Having the information provided as data greatly enhances the commission's ability to use the information and make it available to the other workers' compensation system participants. Use of the Web page option will allow a carrier significant flexibility in how the required information is organized and presented. While the functional areas specified in the proposed amendment must be addressed, the contact points may be grouped if that best suits the carrier's business model. If the carrier chooses, it may provide a single point of contact that can either provide the information required or direct the requester to the appropriate source.

Amended §124.2(c)(1) requires that certain coverage information (insurance carrier FEIN, policy number and policy period) be reported by the insurance carrier in conjunction with the information from the Employer's First Report of Injury and that this information be identical with that reported under §110.1 for the employer associated with the claim.

Amended §124.2(c)(4) requires that the coverage information required by §124.2(c)(1) be reported through a Change transaction if it is not available when the First Report of Injury is submitted to the commission.

New §124.2(n) states the requirement for each insurance carrier to provide to the commission, contact information for the claim service functions of coverage verification, claim adjustment, medical billing, pharmacy billing (if different from medical billing), and preauthorization request processing. Telephone and facsimile numbers, mailing address, and company and/or department e-mail address information for each function shall be provided. Communications and staffing provided by the carrier in response to this subsection shall conform to the requirements of §102.4 of this title (regarding, General Rules for Non-Commission Communications). Each insurance carrier will provide to the commission, through its Austin representative, the contact information for these functions either by creating and maintaining a single World Wide Web (Web) page containing this information and furnishing the Uniform Resource Locator (URL) of that Web page to the commission through its Austin representative or by having the Austin representative make an online submission of the contact information that the commission will make available to the public. It is anticipated that an insurance carrier's Austin representative will provide the URL for its Web page or submit the contact information to the commission through their access to the commission's automation system (TXCOMP).

Comments generally supporting the proposed amendments were received from Texas Mutual Insurance Company. Comments generally opposing the proposed amendments were received from Alliance of American Insurers, American Insurance Association, and The St. Paul Companies, Inc. Comments generally supporting some of the proposed amendments and generally opposing others were received from Insurance Council of Texas.

In addition to supporting or opposing various portions of the rule, commenters made suggestions for improvements to the rules or asked for clarification on certain points. Such comments containing recommendations were received from the following groups: The St. Paul Companies, Inc., Texas Mutual Insurance Company, Alliance of American Insurers, Insurance Council of Texas and American Insurance Association.

Summaries of the comments and commission responses are as follows:

Section 124.2(c)(1)

COMMENT: Commenter supported the proposed amendment of subsection (c)(1) of §124.2.

RESPONSE: The commission concurs.

COMMENT: Commenter did not object to the data reporting requirements in amended subsection (c)(1), but found the proposed language confusing and suggested that the language be modified to clarify that the policy information to be reported was that of the insured not the insurance company.

RESPONSE: The commission agrees that the proposed language would be improved by differentiating between the FEIN, associated with the carrier, and the policy number, policy effective date and policy expiration date associated with the insured employer. Subsection (c)(1) has been changed to clarify this distinction.

COMMENT: Commenter objected to the requirement that a carrier report the carrier FEIN, policy number, policy effective date and policy expiration date on the first report of injury and further objected to the requirement to report the carrier FEIN, characterizing this as a new burden being placed on the carrier, as this information is already provided through the coverage reporting system. Commenter felt that this requirement would not improve the benefit delivery system in any manner. The commenter recommended deletion of the first report of injury data elements from the final rule.

RESPONSE: The commission disagrees. No new information is required to be reported by this rule change. The commission already requires reporting of the carrier's FEIN and the policy information in the first report of injury under the current rule. As discussed earlier in this preamble, only on 58 percent of the first reports of injury received by the commission does the policy number match with a policy number on coverage information provided by the carrier pursuant to §110.1 of this title (regarding Requirements for Notifying the Commission of Insurance Coverage). This amendment simply requires consistency of reporting information between the first report of injury and the coverage information required under §110.1. This consistency of reporting will enable the commission to more efficiently link claims information and coverage information, thereby facilitating better and more efficient customer service by the commission to all system participants

COMMENT: Commenter requested clarification as to whether or not omission of the specified data elements would cause the First Report of Injury to be rejected.

RESPONSE: The carrier FEIN is, and has been for many years, a mandatory data element. Its omission causes the First Report of Injury to be rejected. The policy number, policy effective date and policy expiration date are not mandatory fields and their omission does not cause the First Report of Injury to be rejected.

Section 124.2(n)

COMMENT: The commenter stated that the concept of the commission providing insurance company contact information to system participants was a good idea, although they disagreed with the manner in which the commission proposed to make the information available.

RESPONSE: The commission agrees that improvement of the exchange of claim administration contact information is needed and has provided some new ways to facilitate that exchange. The concerns expressed by the commenter are addressed in responses which follow.

COMMENT: Commenters challenged the commission's statutory authority to require a carrier to create a claims handling contact Web page.

RESPONSE: Section 406.006 of the Texas Labor Code requires insurance carriers to file notice of coverage and claim administration contact information with the commission and authorized the commission to adopt rules that establish the specific information required. Section 406.010 of the Texas Labor Code authorizes the commission by rule to specify the requirements for insurance carrier designation of persons to provide claims service. Section 401.024 of the Texas Labor Code provides that the commission may by rule require the use of an electronic transmission for specified information. "Electronic transmission" means the transmission of information by facsimile, electronic mail, electronic data interchange, or any other similar method. The use of an Internet-based electronic transmission via a Web page is a similar method to the methods listed. Electronic mail is similarly Internet based. Although the commission has the authority to require the use of a Web page as a method of providing claim administration contact information, the amended rule also establishes a method of providing this information without developing a Web page.

COMMENT: Commenter believes the proposed amendments are unnecessary and questioned the need for a specified method of providing carrier claim administrative contact information, contending that the information was available from other numerous, readily available sources such as toll free telephone numbers, general websites, telephone directories, and from the employer.

RESPONSE: The commission disagrees. The commission receives approximately 500 telephone calls per day from workers' compensation system participants, predominately health care providers, requesting contact information for the carrier. The commission does not have this information available in an organized, automated form and has depended on individual customer service employees having personal reference lists. After the commission implemented its online coverage look-up system on the state Web portal (TexasOnline), over sixty percent of the comments received from users of that system asked for the addition of the carrier contact information. This amendment will support the commission's implementation of an enhanced version of the online coverage system that will provide the claim administration contact information.

COMMENT: Commenters contended that developing and maintaining a Web page would add significant cost for the carrier that would be passed on to the employer as higher premiums.

RESPONSE: The commission disagrees. The Web page necessary to convey the claim administration contact information requires a simple, content only page with no functionality. Development and maintenance costs should be minimal. However, to address the concerns of the commenters, the commission has added an optional method of providing the claim administration contact information that, while not offering the flexibility of the Web page option, will be at no cost to the carrier.

COMMENT: Commenter recommended changing the language in §124.2(n)(1)(A) to read "Policy issuance and effective dates of policy", and expressed concern that the term, "Coverage verification questions," would raise the possibility that the contact person is to make determinations regarding the compensability of the claim.

RESPONSE: The Commission agrees and has added the language suggested by the commenter as a parenthetical explanation of the term, "coverage verification." Also, for clarity, the word "questions" was omitted from §124.2(n)(1)(A).

COMMENT: Commenter recommended a 12-month phase-in period for the requirements of §124.2(n).

RESPONSE: The commission agrees that some phase-in period is appropriate, however disagrees that the period should be 12 months. The commission has adopted the amendments with an effective date of November 1, 2003. This will allow carriers a sufficient time to prepare to meet the requirements.

COMMENT: Commenter expressed concern that the organizational layout and contact information would provide insight on how a carrier conducts business, delivers services and which providers it uses for those services. The commenter stated that this information was an asset that the carrier guarded because it differentiates one carrier from another.

RESPONSE: The commission agrees in part. The provider information is not an issue with all carriers because many of them provide these services in-house or through well-known associations. However, to address these concerns for other carriers, the organizational layout information has been removed because this information may reflect the insurance carrier's business practices.

COMMENT: Commenter stated that no other state has such a requirement.

RESPONSE: The commission is not reluctant to be a leader in providing what is clearly a much-needed service to a large portion of the Texas workers' compensation community. The need for improved communication of this contact information is clear and the commission believes that the addition of the no cost method of submitting the information, added in response to carrier concerns is an innovation other states may want to consider.

COMMENT: Commenter expressed concern that this initiative by Texas might lead to similar requirements by other states, resulting in a carrier having to maintain multiple Web pages to meet each state's requirements. Another commenter suggested that the rule specifically state that carriers do not need to provide electronic information on a country-wide basis.

RESPONSE: The commission disagrees. The adopted amendments respond to a specific need of the Texas workers' compensation system. Claim administration contact information necessary for claims in the Texas workers' compensation system is all that is addressed by this rule. In the United States, workers' compensation is a state program and state requirements inherently differ. The alternative process now provided by the current proposal should minimize the financial impact on the carrier by providing a no cost method of complying without being required to develop and maintain a Web page.

COMMENT: Commenter expressed a concern that the system proposed in the amended rule would expose confidential claim information to compromise.

RESPONSE: The commission disagrees. There is no claim-specific information required to be provided and no security exposure beyond that a carrier may have through its own Web based systems.

COMMENT: Commenter expressed concern that insurance carrier employee personal information would be accessible through the system, possibly exposing these employees to unwarranted or threatening contacts.

RESPONSE: The commission disagrees. There is no requirement in the adopted amendment that the contact information contain personal employee information. No individual names are required. Telephone numbers and e-mail addresses should be functional rather than personal.

COMMENT: Commenter provided general opposition to the rule as it might delay service to the injured worker or health care provider if multiple calls were required or the claim had not previously been reported. The commenter also felt that the proposed amendment could be interpreted to require a very complex organizational structure that, in the extreme, could extend down to policy specific information. Commenter recommended that the carrier be allowed to provide a point of contact in the carrier's claim department that could either directly respond to the inquiry or properly direct the caller to someone who could help them and proposed modified language that allowed for a single point of contact.

RESPONSE: The commission agrees that a single point of contact may be preferable, depending on the carrier's organizational structure and method of handling the various claim service administrative functions. The language of the rule has been modified in subsection (n)(1) accordingly to remove the direction on how the information should be organized, thus allowing the carrier flexibility in how this will be done. While contact points for the five functions listed in the proposed amendment are required, if the carrier wishes, all five, or any combination of functions, could be referred to a single contact.

COMMENT: Commenter felt that the five-day requirement to update the contact information, found in subsection (n)(3), was unreasonable and should be extended to twenty calendar days.

RESPONSE: The commission agrees that the five-day requirement proposed may not provide enough time to update contact information. However, the claim administration contact information is useless if it is not current and correct. The proposed rule has been modified to require that the claim administration contact information or URL address be updated within ten working days of a change. The term, "business day," is changed to "working day" for consistency with §102.3(b) of this title (regarding Computation of Time).

COMMENT: Commenter supported the commission's proposed flexibility in the organization of the contact information page and recommended the addition of a §124.2(n)(1)(F) to read: "Other administrative functions reflecting an insurance carrier's business practices." The commenter recommended that the carrier be allowed to include other contact information on the contact page for use by other insurance functions such as insurance agents to check on the status of a quote and policyholders to call regarding their premium audit.

RESPONSE: The commission disagrees that this text should be added. The rule states the required information that the carrier must make available. While the carrier is not prohibited from providing additional contact information on the contact page, the required information must be prominently presented. The focus of the page is to provide contact information for claim administration functions as regulated by the commission.

COMMENT: Commenter suggested as an alternative to the commission's proposed Web page method of providing the claim administration contact information that the commission require each carrier to submit their contact information to the commission as a MS Word document which the commission would compile into a directory, convert to a single Adobe PDF file and make available for download from the commission's Web site.

RESPONSE: The commission disagrees. The commenter's suggested method would require commission action to request the information and to request updates. This would delay the dissemination of the information. Requiring the entity that has the information readily available and knows when it changes enter it directly creates a much more efficient and accurate system.

COMMENT: Commenter requested clarification as to whether the required contact information only applied to contacts concerning Texas workers' compensation claims.

RESPONSE: The commenter's understanding is correct that the requirement only requires contact information regarding entities that handle Texas workers' compensation coverage or claims.

COMMENT: Commenter requested clarification as to whether or not the commission would require the contact information page to be accessible from the carrier's Web site in addition to the commission's Web site.

RESPONSE: The commission intends to make the carrier's contact Web page accessible through the commission's Web site. The carrier is not required to make this same Web page accessible through their own Web site, although the commission would encourage the carrier to provide complete claim service procedure and contact information available to all workers' compensation participants through the broadly accessible medium of the Web.

The amendments are adopted pursuant to the Texas Labor Code §401.011(27), which defines an insurance carrier; Texas Labor Code §401.024, which authorizes the commission to require by rule the use of an electronic transmission of information; Texas Labor Code §402.042, which authorizes the Executive Director to prescribe the form, manner, and procedure for transmission of information to the Commission; Texas Labor Code §402.061, which authorizes the commission to adopt rules necessary to administer the Act; Texas Labor Code §406.006, which requires insurance carriers to report employer coverage and claim administration contact information to the commission; Texas Labor Code §406.010, which requires insurance carriers to provide claims service and to designate sufficient numbers of persons to provide claims service and requires the commission by rule to specify the requirements for such designation; and Texas Labor Code, §409.005, which requires the insurance carrier to file the report of injury on behalf of the policyholder.

The amendments are adopted pursuant to the Texas Labor Code, §§401.011(27), 401.024, 402.061, 406.006, 406.010, and 409.005.

§124.2.Carrier Reporting and Notification Requirements.

(a) An insurance carrier shall notify the Commission and the claimant of actions taken on, or events occurring in a claim as required by this title.

(b) The Commission shall prescribe the form, format, and manner of required electronic submissions through publications such as advisory(ies), instructions, specifications, the Texas Electronic Data Interchange Implementation Guide, and trading partner agreements. Trading partners will be responsible for obtaining a copy of the International Association of Industrial Accident Boards and Commissions (IAIABC) Electronic Data Interchange Implementation Guide.

(c) The carrier shall electronically file, as that term is used in §102.5(e) of this title (relating to General Rules for Written Communication To and From the Commission), with the Commission:

(1) the information from the original Employer's First Report of Injury; the insurance carrier's Federal Employer Identification Number (FEIN); and the policy number, policy effective date, and policy expiration date reported under §110.1 of this title (relating to Requirements for Notifying the Commission of Insurance Coverage) for the employer associated with the claim, not later than the seventh day after the later of:

(A) receipt of a required report where there is lost time from work or an occupational disease; or

(B) notification of lost time if the employer made the Employer's First Report of Injury prior to the employee experiencing absence from work as a result of the injury;

(2) any correction of Commission-identified errors in a previously accepted electronic record as provided in §102.5(e) of this title (Correction);

(3) information regarding a compensable death with no beneficiary (Compensable Death No Beneficiaries/Payees) not later than the tenth day after determining that an employee whose injury resulted in death had no legal beneficiary; and

(4) a change in an electronic record initiated by carrier (Change), the coverage information required by paragraph (1) of this subsection if not available when the First Report of Injury was submitted to the commission and any change in a claimant or employer mailing address within 7 days of receipt of the new address.

(d) The carrier shall notify the Commission and the claimant of a denial of a claim (Denial) based on non-compensability or lack of coverage in accordance with this section and as otherwise provided by this title.

(e) The carrier shall notify the Commission and the claimant of the following:

(1) first payment of indemnity benefits on a claim (Initial Payment) within 10 days of making the first payment;

(2) change in the net benefit payment amount caused by a change in the employee's post-injury earnings (Reduced earnings) within ten days of making the first payment reflecting the change;

(3) change in the net benefit payment amount that was not caused by a change in employee's post-injury earnings, this includes but is not limited to subrogation, attorney fees, advances, and contribution (Change in Benefit Amount) within 10 days of making the first payment reflecting the change;

(4) change from one income benefit type to another or to death benefits (Change in Benefit Type) within 10 days of making the first payment reflecting the change;

(5) resumption of payment of income or death benefits (Reinstatement of Benefits) within 10 days of making the first payment;

(6) termination or suspension of income or death benefits (Suspension) within 10 days of making the last payment for the benefits.

(7) employer continuation of salary equal to or exceeding the employee's Average Weekly Wage as defined by this title (Full Salary) within:

(A) seven days of receipt of the Employer's First Report of Injury or a Supplemental Report of Injury (if the report included information that salary would be continued) if the carrier has not initiated temporary income benefits; or

(B) ten days of making the last payment of temporary income benefits due to the employer's continuation of full salary.

(f) Notification to the claimant as required by subsections (d) and (e) of this section requires the carrier to use plain language notices with language and content prescribed by the Commission. These notices shall provide a full and complete statement describing the carrier's action and its reason(s) for such action. The statement must contain sufficient claim-specific substantive information to enable the employee/legal beneficiary to understand the carrier's position or action taken on the claim. A generic statement that simply states the carrier's position with phrases such as "employee returned to work," "adjusted for light duty," "liability is in question," "compensability in dispute," "under investigation," or other similar phrases with no further description of the factual basis for the action taken does not satisfy the requirements of this section.

(g) Notification to the Commission as required by subsections (c), (d) and (e) of this section requires the carrier to use electronic filing, as that term is used in §102.5(e) of this title. In addition to the electronic filing requirements of this subsection, when a carrier notifies the Commission of a denial as required by subsection (d) of this section, it must provide the Commission a written copy of the notice provided to the claimant under subsection (f) of this section. The notification requirements of this section are not considered completed until the copy of the notice provided to the claimant is received by the Commission.

(h) Notification to the Commission and the claimant of a dispute of disability, extent of injury, or eligibility of a claimant to receive death benefits shall be made as otherwise prescribed by this title and requires the carrier to use plain language notices with language and content prescribed by the Commission. These notices shall provide a full and complete statement describing the carrier's action and its reason(s) for such action. The statement must contain sufficient claim-specific substantive information to enable the employee/legal beneficiary to understand the carrier's position or action taken on the claim. A generic statement that simply states the carrier's position with phrases such as "no medical evidence to support disability," "not part of compensable injury," "liability is in question," "under investigation," "eligibility questioned" or other similar phrases with no further description of the factual basis for the action taken does not satisfy the requirements of this section.

(i) The Commission shall send an acknowledgment to the transmitting trading partner detailing whether an electronically submitted record was accepted, accepted with errors, or rejected. The acknowledgment shall be provided directly to the trading partner submitting the transmission, not through the Austin representative box identified in §102.5 of this title. If the record was accepted with errors in conditional elements, the carrier must correct the errors in accordance with §102.5 of this title.

(j) Except as otherwise provided by this title, carriers shall not provide notices to the Commission that explain that:

(1) benefits will be paid as they accrue;

(2) a wage statement has been requested;

(3) temporary income benefits are not due because there is no lost time;

(4) the carrier is disputing some or all medical treatment as not reasonable or necessary;

(5) compensability is not denied but the carrier disputes the existence of disability (if there are no indications of lost time or disability and the employee is not claiming disability); or

(6) future medical benefits are disputed (notices of which shall not be provided to anyone in the system).

(k) Written requests for a waiver of the electronic filing requirement for the Employer's First Report of Injury may be submitted to the Commission's executive director or his/her designee for consideration. Waivers must be requested at least annually and the requests must include, a justification for the waiver, the volume of the carrier's claims and total premium amounts, current automation capabilities, Electronic Data Interchange (EDI) programming status, and a specific target date to implement EDI. Waivers require written approval from the executive director and shall be granted at the discretion of and for the time frame noted by the Executive Director or his/her designee.

(l) If specifically directed by the Commission, such as through Commission advisory or the Texas Electronic Data Interchange Guide, the carrier may provide the information required in subsection (c), (d), or (e) of this section to the Commission in hardcopy/paper format.

(m) Notifications to the claimant and the claimant's representative shall be filed by facsimile or electronic transmission unless the recipient does not have the means to receive such a transmission in which case the notifications shall be personally delivered or sent by mail.

(n) On or after November 1, 2003, each insurance carrier shall provide to the commission, through its Austin representative in the form and manner prescribed by the commission, the contact information for all workers' compensation claim service administration functions performed by the insurance carrier either directly or through third parties.

(1) The contact information for each function shall include mailing address, telephone number, facsimile number, and e-mail address as appropriate. This contact information may be provided either in the form of a single World Wide Web (Web) Uniform Resource Locator (URL) for a Web page created and maintained by the carrier that contains the required information or through an online submission to the commission.

(A) Coverage verification (policy issuance and effective dates of policy);

(B) Claim adjustment;

(C) Medical billing;

(D) Pharmacy billing (if different from medical billing); and

(E) Preauthorization.

(2) If the Web page option is used the page shall contain the date on which it was last updated and an e-mail address or other contact information to which a user may report problems or inaccuracies.

(3) The insurance carrier shall update the contact information and/or Web URL within ten working days after any such change is made.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303041

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 804-4287


28 TAC §124.7

The Texas Workers' Compensation Commission (the commission) adopts an amendment to §124.7, concerning Initial Payment of Temporary Income Benefits, without changes to the proposed text published in the March 14, 2003, issue of the Texas Register (28 TexReg 2245).

As required by the Government Code §2001.033(1), the commission's reasoned justification for this rule is set out in this order, which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and, if applicable, the reasons why the commission disagrees with any comment or proposal.

No changes were made to the rule as proposed.

Section 124.6 was repealed as part of an earlier rule action which adopted §124.2 (Carrier Reporting and Notification Requirements) and §124.3 (Investigation of an Injury and Notice of Denial/Dispute). As a result, the reference to §124.6 contained in §124.7(c) is inaccurate. This amendment removes that incorrect reference.

Comments supporting the proposed amendment were received from the Insurance Council of Texas.

Summaries of the comments and commission responses are as follows:

COMMENT: Commenter stated that the deletion of a reference to a rule that has been repealed will prevent system participants from becoming confused about the applicability of the repealed rule. The commenter supports the commission's efforts to "clean up" rules by deleting language and rule references that are no longer applicable or relevant.

RESPONSE: The commission agrees.

The amendment is adopted pursuant to the Texas Labor Code, §401.024, which provides the commission the authority to require use of facsimile or other electronic means to transmit information in the system; Texas Labor Code, §402.042, which authorizes the Executive Director to enter orders as authorized by the statute as well as to prescribe the form, manner, and procedure for transmission of information to the commission; Texas Labor Code, §402.061, which authorizes the commission to adopt rules necessary to administer the Act; Texas Labor Code, §406.010, which authorizes the commission to adopt rules regarding claims service; Texas Labor Code, §408.027, which sets out the timeframe and procedures for payment of medical bills; Texas Labor Code, §408.081, which provides that, except as otherwise provided, benefits are to be paid weekly as and when they accrue; Texas Labor Code, §408.082 and §408.101, which define the accrual date for benefits; Texas Labor Code, §409.021, which requires carriers to timely initiate or dispute compensation; and Texas Labor Code, §409.022, which requires a notice of refusal to specify the carrier's grounds for disputing a claim.

The amendment is adopted pursuant to the Texas Labor Code, §§401.024, 402.042, 402.061, 406.010, 408.027, 408.081, 408.082,408.101, 409.021, and 409.022.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303039

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: March 14, 2003

For further information, please call: (512) 804-4287


Chapter 126. GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS

28 TAC §126.11

The Texas Workers' Compensation Commission (the commission) adopts amendments to §126.11, concerning the Extension of the Date of Maximum Medical Improvement for Spinal Surgery without changes to the proposed text published in the April 4, 2003, issue of the Texas Register (28 TexReg 2885).

As required by the Government Code §2001.033(1), the commission's reasoned justification for this rule is set out in this order which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and the reasons why the commission disagrees with some of the comments and proposals.

No changes were made to the proposed rule in response to public comment received in writing and no public hearing was requested or held.

Section 408.026 of the Texas Workers' Compensation Act (the Act) was revised by the 77th Texas Legislature, 2001, to delete the spinal surgery second opinion process and instead establish carrier liability for medical costs related to non-emergency spinal surgery through the preauthorization process as provided by §413.014 (relating to Preauthorization Requirements; Concurrent Review and Certification of Health Care). Section 413.014 directs that all non-emergency spinal surgery procedures require preauthorization approval prior to surgery, and concurrent review approval for the continuation of treatment beyond previously approved treatment.

The statutory revision is applicable only to health care services requested or provided on or after the effective date of rules adopted by the commission. This necessitated a transitory period during which pending requests continued to be processed under the second opinion process of §133.206 and new requests were handled under the preauthorization process in. Following the 2001 Legislative session, the commission amended §133.206 to reflect that it applied only to health care provided or requested prior to January 1, 2002. All of those requests have been finalized and therefore, §133.206 is no longer needed and has been repealed.

Amended §126.11 replaces the rule language that references approval for non-emergency spinal surgery through the spinal surgery second opinion process with the appropriate references to the preauthorization process in §134.600 (relating to Preauthorization Requirements; Concurrent Review and Certification of Health Care).

The language is further amended to delete the reference to §134.1001 (relating to the Spine Treatment Guideline), abolished effective January 1, 2002 by House Bill 2600, 77th Texas Legislature.

Adopted subsection (a) replaces language that references the spinal surgery second opinion section of the commission with language that connects an approval for spinal surgery to the preauthorization process. The language of subsection (a) is further revised to reflect the approval notification source as the insurance carrier (carrier) as provided in the preauthorization process, rather than the commission.

Amended subsection (f)(3) deletes the reference to §134.1001 (the abolished Spine Treatment Guideline).

Amended subsection (j) replaces the language of "concurrence finding" with "preauthorized approval."

Comments supporting the proposed amendment to §126.11 were received from the Insurance Council of Texas.

A summary of the comment and commission response is as follows:

COMMENT: Commenter expressed support of the amendment to §126.11 as a necessary "rule clean-up" to avoid confusion and misinformation.

RESPONSE: The commission agrees.

The amendment is adopted pursuant to the Texas Labor Code, §402.061, which authorizes the Commission to adopt rules necessary to administer the Act; the Texas Labor Code, §402.072, which mandates that only the Commission can impose sanctions which deprive a person of the right to practice before the Commission, receive remuneration in the workers' compensation system, or revoke a license, certification or permit required for practice in the system; the Texas Labor Code, §408.022, which requires an employee receiving treatment under the workers' compensation system to choose a doctor from a list of doctors approved by the Commission and establishes the extent of an employee's option to select an alternate doctor; the Texas Labor Code §408.026, (as amended by HB-2600, 2001 Texas Legislature) that requires the preauthorization of non-emergency spinal surgery; the Texas Labor Code Chapter 410, which provides procedures for the adjudication of disputes; the Texas Labor Code §413.014 (as amended by HB-2600, 2001 Texas Legislature) that requires the commission to specify by rule, except for treatments and services required to treat a medical emergency, which health care treatments and services require express preauthorization and concurrent review by the carrier as well as allowing health care providers to request precertification and allowing the carriers to enter agreements to pay for treatments and services that do not require preauthorization or concurrent review. This mandate also states the carrier is not liable for the cost of the specified treatments and services unless preauthorization is sought by the claimant or health care provider and either obtained or ordered by the commission; the Texas Labor Code §413.031, which provides a process for dispute resolution for disputes involving medical services; the Texas Labor Code, §415.034, which allows a party charged with an administrative violation or the Executive Director of the Commission to request a hearing with the State Office of Administrative Hearings; and the Texas Government Code, §2003.021(c), which requires the State Office of Administrative Hearings to conduct hearings under the Texas Labor Code, Title 5, in accordance with the applicable substantive rules and policies of the Texas Workers' Compensation Commission.

The amendment is adopted pursuant to the Texas Labor Code, §§402.061, 402.072, 408.022, 408.026, Chapter 410, §§413.014, 413.031, 415.034, and the Texas Government Code, §2003.021(c).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303040

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 804-4287


Chapter 133. GENERAL MEDICAL PROVISIONS

The Texas Workers' Compensation Commission (the commission) adopts amendments to §133.2, concerning Sharing Medical Reports and Test Results and the simultaneous repeal of §133.206, concerning Spinal Surgery Second Opinion Process. Section 133.2 is adopted with a minor change to the proposed text as published in the April 4, 2003, issue of the Texas Register (28 TexReg 2888). Section 133.206 is adopted without changes to the proposal and will not be republished.

As required by the Government Code §2001.033(1), the commission's reasoned justification for this rule is set out in this order, which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and the reasons why the commission disagrees with some of the comments and proposals.

No changes were made to the proposed rule in response to public comment received in writing and no public hearing was requested or held. One change was made to §133.2(a) as proposed as a result of staff review.

Section 408.026 of the Texas Workers' Compensation Act (the Act) was revised by the 77th Texas Legislature, 2001, to delete the spinal surgery second opinion process and instead establish carrier liability for medical costs related to non-emergency spinal surgery through the preauthorization process as provided by §413.014 (relating to Preauthorization Requirements; Concurrent Review and Certification of Health Care). Section 413.014 directs that all non-emergency spinal surgery procedures require preauthorization approval prior to surgery, and concurrent review approval for the continuation of treatment beyond previously approved treatment.

Adopted amendments to §133.2(a) remove language that referenced a doctor "performing a second opinion on spinal surgery" to reflect the changes in the Act regarding Spinal Surgery approval procedure and adds a "referral doctor" to the list of doctors to whom the treating doctor is required to forward copies of reports, radiographic films, and test results. In addition, the word "and" has been changed to "or" to clarify that the treating doctor is required to forward medical records to the appropriate doctor per the request.

The repeal of §133.206 reflects the statutory deletion of the spinal surgery second opinion process from the Texas workers' compensation system. The statutory revision is applicable only to health care services requested or provided on or after the effective date of rules adopted by the commission. This necessitated a transitory period during which pending requests continued to be processed under the second opinion process of §133.206 and new requests were handled under the preauthorization process in. Following the 2001 Legislative session, the commission amended §133.206 to reflect that it applied only to health care provided or requested prior to January 1, 2002. All of those requests have been finalized and therefore, §133.206 is no longer needed and has been repealed.

Comments supporting in part and opposing in part the proposed amendment to §133.2 and supporting the repeal of §133.206 were received from the Insurance Council of Texas.

Summaries of the comments and commission responses are as follows:

COMMENT: Commenter expressed support for the repeal of §133.206.

RESPONSE: The commission agrees.

COMMENT: Commenter agreed with the proposed removal of language in §133.2 concerning a doctor providing a second opinion for spinal surgery.

RESPONSE: The commission agrees.

COMMENT: Commenter expressed concern that the amendment of §133.2 could make it difficult for insurers to receive the information they need to make informed decisions regarding preauthorization and to deny unnecessary spinal surgeries, as well as to perform meaningful preauthorization peer reviews. Commenter recommended the addition of language to §133.2 to allow the insurer or insurer's utilization review company performing preauthorization and concurrent review to receive a full set of records, including radiographic and other diagnostic films, from the treating doctor within 10 days of the date the treating doctor receives the written request from the insurer or insurer's utilization review agent.

RESPONSE: The commission disagrees with the proposed language inclusion in §133.2. Because there is no longer a second opinion process for spinal surgery, the suggested addition to the preauthorization process is appropriately considered in the context of §134.600, Preauthorization, Concurrent Review and Voluntary Certification of Health Care, rather than in §133.2 or §133.206 which are the subject of this rule action.

The amendment is adopted pursuant to the Texas Labor Code, §402.061, which authorizes the Commission to adopt rules necessary to administer the Act; the Texas Labor Code, §402.072, which mandates that only the Commission can impose sanctions which deprive a person of the right to practice before the Commission, receive remuneration in the workers' compensation system, or revoke a license, certification or permit required for practice in the system; the Texas Labor Code, §408.022, which requires an employee receiving treatment under the workers' compensation system to choose a doctor from a list of doctors approved by the Commission and establishes the extent of an employee's option to select an alternate doctor; the Texas Labor Code §408.026, (as amended by HB-2600, 2001 Texas Legislature) that requires the preauthorization of non-emergency spinal surgery; the Texas Labor Code Chapter 410, which provides procedures for the adjudication of disputes; the Texas Labor Code §413.014 (as amended by HB-2600, 2001 Texas Legislature) that requires the commission to specify by rule, except for treatments and services required to treat a medical emergency, which health care treatments and services require express preauthorization and concurrent review by the carrier as well as allowing health care providers to request precertification and allowing the carriers to enter agreements to pay for treatments and services that do not require preauthorization or concurrent review. This mandate also states the carrier is not liable for the cost of the specified treatments and services unless preauthorization is sought by the claimant or health care provider and either obtained or ordered by the commission; the Texas Labor Code §413.031, which provides a process for dispute resolution for disputes involving medical services; the Texas Labor Code, §415.034, which allows a party charged with an administrative violation or the Executive Director of the Commission to request a hearing with the State Office of Administrative Hearings; and the Texas Government Code, §2003.021(c), which requires the State Office of Administrative Hearings to conduct hearings under the Texas Labor Code, Title 5, in accordance with the applicable substantive rules and policies of the Texas Workers' Compensation Commission.

Subchapter A. GENERAL RULES FOR REQUIRED REPORTS

28 TAC §133.2

The amendment is adopted pursuant to the Texas Labor Code, §402.061, §402.072, §408.022, §408.026, Chapter 410, §413.014 §413.031, §415.034, and the Texas Government Code, §2003.021(c).

§133.2.Sharing Medical Reports and Test Results.

(a) The treating doctor within 10 days of receipt of a written request shall forward to a referral doctor, consulting doctor, designated doctor, or a doctor that is examining the claimant under a medical examination order, copies of reports required in any rules in this part, radiographic films, and test results, to prevent unnecessary duplication of tests and examinations. An attending emergency doctor or facility will send copies of medical reports and other information to the treating doctor upon request.

(b) When the claimant changes treating doctors, the subsequent treating doctor will contact, in writing, the previous doctor or, if unable to contact the previous doctor, will contact the carrier to obtain copies of all required written medical reports pertinent to the injury and test results submitted to the carrier. The written request will include a signed waiver from the claimant releasing the claimant's medical records to the subsequent treating doctor. The previous doctor will send all information to the subsequent doctor within 10 days of receipt of the written request.

(c) The previous treating doctor shall charge the carrier no more than the fair and reasonable cost as specified in §133.106(f) of this title (relating to Fair and Reasonable Fees for Required Reports and Records) for copies of required reports and test results when the copies are forwarded to the subsequent treating doctor. The carrier shall reimburse the reasonable copying charge for records provided to designated doctors, or a doctor performing a required medical examination.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303042

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 804-4287


Subchapter C. SECOND OPINION FOR SPINAL SURGERY

28 TAC §133.206

The repeal is adopted pursuant to the Texas Labor Code, §402.061, which authorizes the Commission to adopt rules necessary to administer the Act; the Texas Labor Code, §402.072, which mandates that only the Commission can impose sanctions which deprive a person of the right to practice before the Commission, receive remuneration in the workers' compensation system, or revoke a license, certification or permit required for practice in the system; the Texas Labor Code, §408.022, which requires an employee receiving treatment under the workers' compensation system to choose a doctor from a list of doctors approved by the Commission and establishes the extent of an employee's option to select an alternate doctor; the Texas Labor Code, §408.026, (as amended by HB-2600, 2001 Texas Legislature) that requires the preauthorization of non-emergency spinal surgery; the Texas Labor Code, Chapter 410, which provides procedures for the adjudication of disputes; the Texas Labor Code, §413.014 (as amended by HB-2600, 2001 Texas Legislature) that requires the commission to specify by rule, except for treatments and services required to treat a medical emergency, which health care treatments and services require express preauthorization and concurrent review by the carrier as well as allowing health care providers to request precertification and allowing the carriers to enter agreements to pay for treatments and services that do not require preauthorization or concurrent review. This mandate also states the carrier is not liable for the cost of the specified treatments and services unless preauthorization is sought by the claimant or health care provider and either obtained or ordered by the commission; the Texas Labor Code, §413.031, which provides a process for dispute resolution for disputes involving medical services; the Texas Labor Code, §415.034, which allows a party charged with an administrative violation or the Executive Director of the Commission to request a hearing with the State Office of Administrative Hearings; and the Texas Government Code, §2003.021(c), which requires the State Office of Administrative Hearings to conduct hearings under the Texas Labor Code, Title 5, in accordance with the applicable substantive rules and policies of the Texas Workers' Compensation Commission.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303043

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 804-4287


Chapter 165. REJECTED RISK: INJURY PREVENTION SERVICES

28 TAC §165.6

The Texas Workers' Compensation Commission (the commission) adopts an amendment to §165.6, concerning the Follow-up Inspection of the Policyholder's Premises by the Division without changes to the proposed text published in the April 4, 2003, issue of the Texas Register (28 TexReg 2890) and will not be republished. The amendment corrects the reference to an article of the Texas Insurance Code.

As required by the Government Code, §2001.033(1), the commission's reasoned justification for this rule is set out in this order which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and the reasons why the commission disagrees with some of the comments and proposals.

No changes were made to the rule as proposed in response to public comment received in writing and no public hearing was requested or held.

During a review of §165.6, it was noted that the reference to the Texas Insurance Code in subsection (a) was incorrect. The rule cites Texas Insurance Code, Article 5.76, §10(d) as the article requiring policyholders to obtain a safety consultation. The article cited should be Article 5.76-3, §8(c). This amendment removes the inaccurate reference and replaces it with the proper one.

Comments supporting the proposed amendment to §165.6 were received from the Insurance Council of Texas.

A summary of the comment and commission response is as follows:

COMMENT: Commenter expressed support of the amendment to §165.6 as a necessary "rule clean-up" to avoid confusion and misinformation.

RESPONSE: The commission agrees.

The amendment is adopted pursuant to Texas Labor Code, §402.061, which authorizes the Commission to adopt rules necessary to administer the Act; Texas Labor Code, Chapter 415, which sets out prohibited acts, penalties, and procedures for administrative violations; and Texas Insurance Code, §5.76-3, which authorizes and sets out the provisions for the Texas Mutual Insurance Company.

The amendment is adopted pursuant to Texas Labor Code, §402.061, Texas Labor Code, Chapter 415, and Texas Insurance Code, §5.76-3.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303044

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 804-4287


Chapter 180. MONITORING AND ENFORCEMENT

Subchapter B. MEDICAL BENEFIT REGULATION

28 TAC §§180.20, 180.21, 180.23

The Texas Workers' Compensation Commission (the commission) adopts amendments to §180.20 (Commission Approved Doctor List), §180.21 (Commission Designated Doctor List), and §180.23 (Commission Required Training for Doctors/Certificate of Registration Levels) with changes to the proposed text published in the March 14, 2003, issue of the Texas Register (28 TexReg 2274).

As required by the Government Code §2001.033(1), the commission's reasoned justification for this rule is set out in this order, which includes the preamble, which in turn includes the rule. This preamble contains a summary of the factual basis of the rule, a summary of comments received from interested parties, names of those groups and associations who commented and whether they were for or against adoption of the rule, and the reasons why the commission disagrees with some of the comments and proposals.

The Texas Register published text shows the adopted language and should be read to determine all revisions. The commission held a Public Hearing on April 11, 2003 regarding the proposed changes, and no comments were provided at that time. Changes made to the proposed rules are in response to public comment received in writing and are described herein, including those based upon further review by staff, including the Medical Advisor and recommendations of the Medical Advisor regarding these rules. Other changes were made to clarify intent, to better match statutory provisions, to improve consistency and to correct typographical or grammatical errors. Changes in the proposed text are found in §180.20 (h)(3) and (4), (k), and §180.23(c)(1)(B) and (D), (h)(4), and (i) and are described in the overview of the rules and the responses to the public comments.

These amendments have been made to address various issues that have arisen with respect to rules adopted or amended in February 2002 regarding the commission's statutory Approved Doctor List (ADL). House Bill 2600 (HB-2600), enacted by the 77th Texas Legislature in its 2001 session, made numerous amendments to the Texas Workers' Compensation Act (Act). Many of those changes related to regulating medical benefit delivery by: changing the commission's approved doctor list (ADL) and application process (including mandated training); changing the grounds under which the commission can issue sanctions (as well as expanding the sanctions); adding a Medical Advisor to the commission staff and a Medical Quality Review Panel (MQRP); and providing for expanded financial disclosure and prohibiting inappropriate referral fees, kickbacks, or other financial incentives. The February 2002 rule amendments and additions to Chapter 180 were based upon these legislative changes.

HB-2600 mandated that the commission develop a list of doctors who are licensed in this state and approved to provide health care under the Act. HB-2600 also required the commission to establish by rule requirements regarding application and registration, training, and impairment rating testing. HB-2600 mandated that doctors who provide health care services in the Texas workers' compensation system be approved by the commission. In the past, only treating doctors were required to be on the ADL. As of September 1, 2003, the requirement to be approved by the commission will apply to doctors who provide health care services as treating doctors, referral doctors, consulting doctors, required medical examination doctors, peer review doctors, utilization review doctors, designated doctors, and doctors on the MQRP.

HB-2600 also mandated that the commission set up modified training and registration requirements for certain types of doctors such as those who infrequently provide care in the Texas workers' compensation system or those who only perform peer reviews and utilization review. Doctors from other states are permitted to be on the ADL. However, out of state doctors who review health care services (such as through utilization review or peer reviews) are required to be supervised by a doctor licensed in Texas.

To help evaluate behavior of doctors and carriers (as relates to medical benefit delivery), HB-2600 created an official Medical Advisor position that is imbued with specific authority and responsibilities. Also created was the MQRP which functions to assist the Medical Advisor in reviewing the conduct of doctors and carriers relating to medical benefit delivery.

It is these mandates that were the primary motivation for the February 2002 action which adopted eight new rules: §180.20 (relating to Commission Approved Doctor List); §180.21 (relating to Commission Designated Doctor List); §180.22 (relating to Health Care Provider Roles and Responsibilities); §180.23 (relating to Commission Required Training for Doctors/Certification Levels); §180.24 (relating to Financial Disclosure); §180.25 (relating to Improper Inducements, Influence and Threats); §180.26 (relating to Doctor and Insurance Carrier Sanctions); and §180.27 (relating to Sanctions Process/Appeals/Restoration/Reinstatement).

The February 2002 rule revisions and additions were necessary to implement the HB-2600 statutory revisions. These revisions and additions were sweeping in content and established a new process for applying for and obtaining approval to be on the ADL. HB-2600 also required the commission to set a date (not to exceed 18 months from the date of adoption) after which doctors must comply with the new registration and training requirements imposed by the rules. The time lag was intended to provide doctors a reasonable period to comply with the new ADL registration and training requirements. To assist doctors with the transition, the commission has instituted several methods to provide education regarding the new requirements.

Announcements have been published in various medical publications, notices sent to email distribution lists, information has been posted on the commission website and within monthly project newsletters, and a notification campaign has begun by mail that will reach thousands of doctors throughout the summer. The date for doctors to comply with the new requirements was set as September 1, 2003. In the intervening months, the commission has actively worked toward that date. Much groundwork had to be laid so the commission would be able to conduct meaningful evaluations of ADL applicants. For instance, the commission has worked with the various state agencies that license and regulate doctors so the ADL evaluation will include affirmation that the applicant has an active license to practice, and an assessment of any sanction, conditions, or restrictions placed on the license by the licensing board. In addition, the commission and the Research and Oversight Council (ROC) have dedicated time and resources to reviewing the commission's existing medical billing database and developing programs that enable the commission to use the database to identify statistical outliers among the health care providers that provide treatments and services and are reimbursed within the workers' compensation system. The commission Medical Advisor has worked diligently to establish a panel of qualified health care providers that constitute the MQRP and to establish a process for identifying doctors whose health care patterns should be reviewed. A mechanism for that comprehensive review and recommendations from the MQRP and the Medical Advisor have been developed regarding admission to and removal from the ADL and other sanctions authorized by the Act and commission Rules. The commission has written training manuals and modules for online training, secured vendors to provide the participatory training required for impairment testing and ratings, created the ability to file an ADL application online, and developed the means by which all system participants may check the ADL status of a doctor online. Additionally, the commission has developed a method to provide insurance carriers with a downloadable data file of current ADL providers so that carriers can implement automated processes for integrating their medical bill review audits with the validation of a doctor's current ADL status.

These amendments reaffirm the previously adopted Chapter 180 rules, which prevent doctors who do not apply to be on the ADL as of September 1, 2003 from performing services or receiving reimbursement in the Texas workers' compensation system. Because of the 18-month time lag between adoption of the rules and the effective date of the requirement to apply to be on the ADL, and because of the large amount of work that was necessary for the transition, these amendments to the previously adopted Chapter 180 rules focus on sufficient access to health care for injured employees and evaluation of health care or income benefit eligibility for carriers as required by §408.023(i) of the Act. The amendments address three major issues in the transition to the new ADL.

While the commission has the necessary processes in place for the online submission and review of doctor applications, processing the estimated 25,000 to 30,000 ADL applications by September 1, 2003 may strain the time and resources of commission staff. The new ADL requirements for registration, training, evaluation, and a meaningful review for quality care can be time consuming. HB-2600, by necessary implication, argues against indiscriminate placement of doctors on the ADL without a meaningful review for quality care. However, it is essential to have a sufficient number of doctors available to provide services to injured employees.

The commission is addressing this potential impact on access to care by exercising its statutory authority under §408.023(i) of the Act to grant exceptions to the requirement to be on the ADL. Amendments to §180.20(e) provide that the commission may provide a temporary exception to the requirement to be on the ADL while the doctor's application review is completed. A temporary exception will allow a doctor to be reimbursed in accordance with the Act and Rules. The doctor must have successfully completed the training, application, and financial disclosure required of all applicants. A temporary exception does not constitute "being on the ADL," "approval to be on the ADL," or "denial to be on the ADL." Further amendments to §180.20(h)(2) provide that a temporary exception to the requirement that a doctor be on the ADL allows a doctor to be reimbursed in accordance with the Act and Rules, for directly or indirectly providing reasonable and necessary health care (other than emergency or immediate post-injury medical care) or other medical services (such as peer reviews, utilization reviews, reviews by independent review organizations, or other evaluations).

A second issue was whether the contents and length of the training required could discourage a doctor whose practice does not, by its very nature, include ongoing medical management of injured employees from seeking admission to the ADL. If this proved to be true for a significant number of these doctors, access to some services could be adversely affected. The commission Medical Advisor and staff identified the types of medical practices in this category: Anesthesiology - surgical only (excludes pain management), Pathology, and Radiology.

Section 408.023 of the Act requires the commission to establish reasonable training requirements for doctors and health care providers financially connected to those doctors. The Act and existing commission rules recognize that not all doctors need to have the same level of training. The rules amended and adopted to be effective March 14, 2002 established two levels of training and certification. A Level 1 Certificate of Registration allows a doctor to infrequently provide health care to injured employees, perform utilization review or peer review functions; and/or participate in a regional network established under §408.0221 of the Act. Application for a Level 1 Certificate of Registration requires completion of the Limited Participation Doctor Training Module and requires reapplication and follow-up training every two years. A Level 2 Certificate of Registration allows a doctor to serve a more expanded role in the Texas workers' compensation system. Level 2 Certification requires completing the Doctor Training Module and requires reapplication and follow-up training every four years. Level 2 training qualifies a doctor to become a designated doctor with additional training. Authorization to certify MMI when there is permanent impairment and assign an impairment rating is now separate from the doctor's Level 1 or Level 2 Certificate of Registration and requires the doctor to become authorized as an Impairment Rating Doctor (IR Doctor). IR Doctor authorization requires a Level 1 or 2 ADL Certificate of Registration (or a temporary exception) with successful completion of the Impairment Rating Training Module, a passing score on the Impairment Rating Skills Examination, and reapplication and follow-up training every four years. This authorization is optional; however, doctors who choose not to seek authorization as IR Doctors are not permitted to certify MMI or assign an impairment rating in cases where the employee has permanent impairment as a result of the compensable injury.

To ensure that there are a sufficient number of doctors to perform functions that do not include ongoing medical management of injured employees, the rules allow these doctors to complete the shorter, relevant training within the online application itself. There is now a third level of training. This allows these doctors to take training relevant to their role and immediately continue with the online application process. However, if the doctor with one of the above identified medical practices provides ongoing medical management of injured employees, that doctor will be required to take either the Doctor Training Module or the Limited Participation Doctor Training Module. As an example, an anesthesiologist who provides pain management treatments is considered to be participating in the ongoing medical management of the injured employee and is therefore required to complete either the Doctor Training Module or the Limited Participation Doctor Training Module. Based on performance monitoring, the commission may modify the required training as appropriate.

The third significant issue surrounding these rule amendments related to out-of-state doctors applying to be on the ADL and the requirement of the doctor to provide a signed sponsorship affidavit by a doctor who is licensed in this state, who is on the ADL with a Level 2 Certificate of Registration, and who agreed to direct the out-of-state doctor's reviews. The requirement for affidavits to be submitted with a doctor's application has been removed from §180.20(c)(7) in recognition of the fact that a peer review doctor may work for more than one carrier, and that medical directors for carriers change over time. The amended rule further clarifies that the carrier requesting such a review has the responsibility to ensure that the work was performed under the direction of a doctor who is appropriately licensed in Texas and is on the ADL with a Level 2 Certificate of Registration. The carrier, upon request, must identify the directing doctor and present documentation that the review was performed under the direction of that doctor.

In summary, the commission is amending these three Chapter 180 rules to ensure that there are a sufficient number of qualified doctors of all types on and after September 1, 2003 to provide access to health care for injured employees and to provide evaluation of health care or income benefit eligibility for carriers.

New language is added to §180.20 (h)(3) as it was proposed to clarify that a doctor who is entitled to reimbursement based on paragraph (2)(A) and (B) of this subsection may perform medical services and bill for these services only after notification of such entitlement from the commission.

New language is added to §180.20 (h)(4) as it was proposed to clarify that a carrier who receives a bill from a doctor who is not entitled to reimbursement pursuant to §180.20(h)(2) shall deny the medical bill and send the required explanation of benefits (EOB) with appropriate payment exception code. The carrier may wish to inform the doctor of the commission's online process for application to the ADL, by directing the doctor to the commission's website: http://www.twcc.state.tx.us/information/doctorreq.html

Because new §180.20(h)(3) is added, subsequent subparagraphs have been renumbered.

Section 180.20(k) is amended to delete use of the terms "agreement or" because this use of the term "agreement" is inconsistent with the definition stated in §401.011(3) of the Act.

Section 180.23(c)(1)(B) is changed to clarify that a Level 1 Certificate of Registration allows a doctor to perform any utilization review or peer review functions, not just those reviews requested by a carrier.

Section 180.23(c)(1)(D) is amended to allow doctors with a Non-Medical Management designation to participate in regional networks established under §408.0221 of the Act, within the limitations of that designation.

Section 180.23(h)(4) is amended to delete use of the terms "agreement or" because this use of the term "agreement" is inconsistent with the definition stated in §401.011(3) of the Act.

Section 180.23(i)(1) is changed to clarify that doctors with exceptions to the requirement to be on the ADL are permitted to determine if permanent impairment exists and if no permanent impairment exists, to certify MMI. If there is permanent impairment, only a doctor who has successfully completed the IR training and testing requirements may certify MMI and assign impairment. This includes a doctor who has been granted a temporary exception.

Amendments to §180.20. Commission Approved Doctor List.

Subsection (a) is amended to reference §180.1 (relating to Definitions) for clarity as to the definition of the phrase "immediate post-injury medical care." A new (a)(1) is added that now states that the ADL as it exists prior to August 31, 2003 is null and void and any doctor that does not reapply to be on the ADL or whose application is not approved will not be on the ADL as of September 1, 2003. This provides clarity that being on the ADL list that exists as of August 31, 2003 and prior to that date does not entitle a doctor to provide and bill for health services on or after September 1, 2003; that there is a required application process and commission approval process for those desiring to be on the new ADL.

Amendments to subsection (b)(1) and (2) reflect the amended title of §180.23.

Amendments to subsection (c) clarify that an incomplete application will be rejected and will not be processed by the commission. This will prevent use of limited commission and MQRP resources to review incomplete applications.

Multiple amendments throughout subsection (c) relate to what shall be included in an application to the ADL. Subsection (c)(2) now requires that the application include the module of training that was taken and the date the training was completed. The training covers basic requirements of the workers' compensation system and focuses on return to work, efficient utilization of care, entitlement to benefits, maximum medical improvement (MMI), and the determination of the existence of permanent impairment. The key difference between the training modules is the intensity and depth of the material, not the content itself. Such required documentation of training will enable the commission and the doctor to have a record of the relevant workers' compensation information that was current at the time the doctor took the training and subsequently applied to be on the ADL.

As previously discussed, amendments to subsection (c)(7) delete the requirement that a doctor who is not licensed in Texas but wishes to perform utilization and/or peer reviews for a carrier or his agent, must submit a signed sponsorship affidavit by a doctor licensed in Texas who has agreed to direct the doctor's reviews. The requirement could have proven onerous given that a peer review doctor may work for more than one carrier (and therefore have more than one Texas-licensed doctor directing the peer reviews) and that medical directors that work for carriers change over time. Direction under a Texas-licensed doctor is a statutory requirement, so the amended subsection requires the carrier who uses such a doctor to ensure that the review is performed under the direction of an appropriately licensed doctor who is on the ADL with a Level 2 Certificate of Registration, and also requires that the carrier, upon request, present documentation that the review was performed under the direction of that doctor.

A new subsection (c)(8), as previously discussed, addresses doctors who are applying for a Level 1 Certificate of Registration with a Non-Medical Management designation. The new language requires the doctor to indicate on the application that the doctor's practice does not include ongoing medical management of injured employees, and clarifies that doctors providing pain management are considered to be participating in the ongoing medical management of injured employees. This rule amendment addresses access issues as discussed above.

Amendments to subsection (d) and (g)(4) (formerly (f)(4)) clarify that approval to be on the ADL may be issued with "conditions" as well as "restrictions" to be consistent with the statute (§408.023 and §408.0231), other portions of the rule, and §180.26.

New subsection (e) adds language relating to the commission's authority to grant temporary exceptions to the requirement to be on the ADL. A doctor with a temporary exception must meet all the requirements that doctors on the ADL must meet. A temporary exception does not constitute "being on the ADL," "approval to be on the ADL," or "denial of an application to be on the ADL." As discussed above, temporary exceptions are provided to address access issues.

Amendments to subsection (f), (formerly subsection (e)), delete language stating that an incomplete application will result in a denial to the ADL. An incomplete application will now be rejected and not processed in accordance with subsection (c) of this section. This will prevent use of limited commission and MQRP resources to review incomplete applications.

Amendments to (f)(3), (formerly (e)(4)), clarifies that a doctor may be denied admission to the ADL or admitted with conditions or restrictions for activities that would warrant application denial or restriction such as grounds that would require or allow the Medical Advisor to recommend deletion from the ADL or sanction of a doctor. Commission §180.26 (Doctor and Insurance Carrier Sanctions), includes a list of items for which the Medical Director is required to recommend deletion of a doctor from the ADL and a list of items for which the Medical Advisor may recommend sanction or deletion or suspension from the ADL. The amendments to (f)(3) clarify that any of the grounds in any of the lists may be the basis for ADL application denial or restriction. The former language was unintentionally restrictive.

What was formerly subsection (g) is deleted because the concepts expressed in that subsection are modified and incorporated into other subsections.

Subsection (h) is amended with reformatting and better organization of the provisions explaining when a doctor is entitled to reimbursement. Additionally, the concept of temporary exceptions to the ADL is incorporated here as well. As discussed above, the text from the rule as proposed is revised in the adopted rule to clarify the point in time when a doctor is entitled to reimbursement, and to clarify what is required of a carrier upon receipt of a bill from a doctor who is not entitled to reimbursement. This should prevent confusion and differing interpretations of the rule by health care providers, insurance carriers, attorneys, and commission staff.

Amendments to subsection (i) state that the information provided by the commission through its Internet website will include the names and information about doctors who have been granted a temporary exception to the requirement to be on the ADL. Amendments to subsection (i)(1) also conform with the amendments to subsection (c) by stating that the lists provided by the commission will include the names and information about doctors whose application to be on the ADL has denied, but not those whose application was rejected because it was incomplete. New subsection (i)(5) requires the commission to include a list of doctors who have been granted a temporary exception to the requirement to be on the ADL, or have been granted an exception on a case-by-case basis. This will aid system participants in complying with the statutory and rule requirements regarding the ADL and reimbursement for medical services.

Subsection (j) formerly required doctors who are on the ADL to provide the commission with updated information within a certain timeframe. The amendments place the same requirements on ADL applicants because of the provisions that are now in the rule regarding granting a temporary exception to a doctor whose application has not yet been approved or denied.

New subsection (k) provides that Level 1 Certificates of Registration are valid for two years from date of issuance, and Level 2 Certificates of Registration are valid for four years from date of issuance unless the Certificate provides otherwise, the date is revised by commission order or decision, or the doctor has been removed from the ADL. This clarifies the commission's intent when the rule was adopted. As mentioned previously, this subsection was revised from the rule as proposed by deleting use of the term "agreement" to avoid inconsistency with the statutory definition of "agreement" and changing it to "agreed settlement pursuant to §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or Texas Government Code §2001.056 (relating to Informal Disposition of Contested Case)." The amendments also allow the commission to stagger expiration and renewal dates which should aid in efficient use of limited commission and MQRP resources. Additionally, this subsection clarifies that doctors must reapply for the ADL upon expiration of their Certificate of Registration as was intended when the rule was adopted.

Amendments to §180.21. Commission Designated Doctor List.

Amendments to subsection (c) specify that, to be a Designated Doctor, a doctor must be currently active on the ADL with a Level 2 Certificate of Registration with no condition(s) or restriction(s), or must have a temporary exception to the requirement to be on the ADL, thus incorporating the concept of a temporary exception in the Designated Doctor List (DDL) rules, as done in the ADL rules.

What was formerly subsection (d) is deleted and remaining subsections are redesignated accordingly. The text of former subsection (d) failed to make a clear distinction between the old DDL and the new DDL, because it contained text about deletion from the existing DDL. In reality, just as with the ADL, the DDL existing as of and prior to August 31, 2003, will no longer exist, so there is no list from which to be deleted. The potentially confusing text is deleted and is clarified elsewhere in the adopted rules.

Amendments to subsection (d), (formerly subsection (e)), contains new language stating that incomplete applications to the DDL will be rejected and not processed, as with incomplete applications to the ADL. This will prevent use of limited commission and MQRP resources to review incomplete applications.

Amendments to subsection (f), (formerly subsection (g)), reference the requirements of (c) (1) of this section (which incorporates the concept of the temporary exception to the requirement to be on the ADL), and adds clarity and consistency to the organization of the grounds for denial of admission to the DDL.

Amendments to §180.23 - Formerly titled "Commission Required Training for Doctors/Certification Levels," Amended title "Commission Required Training for Doctors/Certificate of Registration Levels"

Amendments to subsection (a) replace the word "certified" with the more appropriate word "approved." "Certified" has very specific connotations in some instances, and could be confusing if used here.

Amendments to subsection (b) clarify that exceptions to training or registration requirements or authorization to perform functions not normally permitted by the doctor's Certificate of Registration may be granted (rather than shall), and when granted, are granted on a per-request, per-case basis.

Amendments to and new language in subsection (c) introduce the concept of a Level 1 Certificate of Registration with a Non-Medical Management designation. As previously discussed, existing training requirements could result in insufficient access to doctors whose practice does not, by nature, include ongoing medical management of injured employees. The rule states the types of medical practices that the commission has determined are in this category: Anesthesiology - Surgical Only (excludes pain management), Radiology, and Pathology. The amendments to this subsection allow doctors with a Non-Medical Management designation to provide medical services to an unlimited number of Texas workers' compensation claimants. Additions to this subsection also clarify that doctors with this designation are not allowed to perform any of the functions listed in subparagraphs (B) of this subsection (utilization review or peer review). As discussed above, the rule as proposed has been revised in the adopted rule to allow a doctor with a Designated Doctor List (DDL) designation to participate in a network and to clarify that a doctor with a Level 1 Certificate of Registration may perform may perform any utilization review or peer review functions, not just those reviews requested by a carrier. These amendments address access issues. Other amendments to subsection (c) reflect the amended title of §180.23, as do amendments to subsection (g)(1)(B).

Amendments to subsection (h) clarify that the Certificates of Registration will expire and require renewal as was intended when the rule was adopted. Paragraph (3) allows the commission to prescribe different training by doing so on the application form for Level 1 Certificate of Registration. This allows the commission to specify different training requirements for a Level 1 Non-Medical Management Certificate of Registration and to revise those requirements as monitoring may show to be appropriate in the future. This addresses access issues. Paragraph (4) contains amended language addressing the renewal of Certificates of Registration and allowing the requirement for follow-up training for Certificates to be modified if the Certificate provides another date; the date is revised by commission order or decision; or the doctor has been removed from the ADL. This will allow staggered expiration and renewal dates, which should aid in efficient use of limited commission and MQRP resources. As discussed above, this subsection is revised from the rule as proposed by deleting use of the terms "agreement or" to avoid inconsistency with the statutory definition of "agreement" and changing it to "agreed settlement pursuant to §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or Texas Government Code §2001.056 (relating to Informal Disposition of Contested Case)."

Also as discussed above, subsection (i) is revised from the rule as proposed to incorporate into the MMI/IR provisions, the concept of a temporary exception to the requirement to be on the ADL, as is done in other sections of the amended rules.

Other amendments are proposed and adopted for consistency of terminology and consistency with other Chapter 180 Rules.

Comments supporting the proposed amendments to §180.20 - 180.21 and §180.23 were received from Insurance Council of Texas.

Comments opposing the proposed amendments to §180.20 - 180.21 and §180.23 were received from Flow Enterprises, Inc.

In addition to supporting or opposing various portions of the rules, commenters made suggestions for improvements to the rules or asked for clarification on certain points. Such comments containing recommendations were received from the following groups: Insurance Council of Texas; Texas Chiropractic Association; and Texas Mutual Insurance Company.

Summaries of the comments and commission responses are as follows:

General

COMMENT: Commenter provided general opposition to the proposed rules and indicated that doctors are not willing to attend a course to continue to treat injured employees. Commenter implied that such a concept is discriminatory to both the injured employees and employers, and the rule changes are not the answer to fraud within the system.

RESPONSE: The commission disagrees that doctors are not willing to take an online training course every two or four years. House Bill 2600 (HB-2600), Article 1, enacted in the 2001 Legislative Session, changed the statutory mandates for doctors in the system to be better educated about the requirements of the workers' compensation system, and consequently changed the way doctors are allowed to participate in the system from automatic inclusion (based upon initial licensure) to a privilege which must be sought through application. As a result of this legislative change, the Chapter 180 rules were adopted and established reasonable training requirements for doctors who wish to be on the ADL. This training can be completed via self-study/distance learning and should not deter qualified conscientious doctors from participating in the system. There are two online training modules for doctors: the Limited Participation Doctor Training Module, which offers a Level 1 Certificate of Registration with the requirement of renewed training in two years; and the Doctor Training Module, which offers a Level 2 Certificate of Registration with the requirement of renewed training in four years. In addition, these amendments allow for a third level of training, Non-Medical Management, that allows doctors within this category to take training relevant to their role and to immediately continue with the online application process. This will ensure that there are sufficient number of doctors of this type to perform functions that do not include ongoing medical management of injured employees. The commission further disagrees with commenter's implication that such training requirements are discriminatory to any system participant. The training is designed to assist doctors as the proposed rules are not intended to be the answer to fraud within the system.

Rule l80.20

COMMENT: Commenter supported the adoption of the proposed amendments to §180.20.

RESPONSE: The commission agrees that the amended rules are necessary changes to ensure access to quality health care as and when needed and access to evaluations of health care and income benefit eligibility.

Subsection (a)

COMMENT: Commenter recommended deletion of the phrase in subsection (a), "immediate post-injury medical care" when used in the same context as "emergency medical care." Commenter asserted that by definition in §180.1(11), a significant interim period of time may elapse between the actual date of injury and the "first date of medical attention," and further stated that only doctors on the ADL should be able to treat in situations other than "emergency care."

RESPONSE: The commission disagrees with the recommendation to delete the phrase "immediate post-injury medical care." Section 408.023(f) of the Act provides an exception from the ADL requirement for a doctor performing immediate post-injury medical care and authorizes the commission to define this term. The definition for "immediate post-injury medical care" is set out in §180.1(11), and is limited to health care provided on the date that the employee first seeks medical attention.

Subsection (b)(3)

COMMENT: Commenter recommended adding language to require a signed statement if no financial interests exists. Commenter stated this would alleviate the possibility that this disclosure could be omitted on the application.

RESPONSE: The commission disagrees that the recommended language addition is necessary because the application process is already designed to capture this information in the event the doctor applying has no financial disclosures. The doctor is instructed to indicate within the application whether or not there is a disclosure to make.

Subsection (c)(7)

COMMENT: Commenter requested clarification as to what is acceptable documentation to prove that the review was performed under the direction of an in-state doctor. Commenter further requested a description or list of examples of appropriate documentation.

RESPONSE: The commission disagrees that further clarification by use of examples within the rule is necessary. The amended rule requires the carrier to provide upon request the identity of the directing in-state doctor and documentation that the review was performed under the direction of that doctor. Because documentation will vary from case-to-case the rule allows carriers the flexibility to provide documentation appropriate and available in a particular case. The documentation will most likely be the in-state doctor's acknowledgement (e.g., initials, email, signature block, etc.) that the review was performed under his/her direction.

Subsection (g)

COMMENT: Commenter recommended the following additional wording: "The Commission shall notify a doctor of the commission's approval or denial within 60 days of receiving a complete application; or, within 60 days notify the applicant of the date the decision will be issued. If no decision is issued within 60 days of application, the applicant is granted an automatic temporary exception until final adjudication is reached on the application." Commenter's rationale is that there should be a definite time frame for the commission to respond to applications. Commenter further stated that as proposed in the rule, the commission may simply not act upon an application instead of denying or restricting a doctor, and consequently, the ADL applicant would have no due process as outlined for adverse decisions.

RESPONSE: The commission agrees in part with commenter's recommendations. The commission agrees that it is important for the applicant doctor to know the status of the application in a timely manner. However, the commission disagrees with the addition of a 60-day deadline for decision on the application. The online application design being used by the commission enables the doctor and the commission staff to work together through email or other means of communication towards completion of the application itself. The commission will then review the information for accuracy and may need to verify certain types of information. Because this review will require sufficient time to complete and because it is not known how many applications will be processed or how many will be filed in the last months before September 1, 2003, a specific time for completing this task has not been included. Commission staff will endeavor to provide a response to the applicant doctor as soon as possible. To address this concern, the commission has created through this amended rule the category of "temporary exception" which allows a doctor to participate in the system while the doctor's application is processed.

Subsection (h)

COMMENT: Commenter recommended deletion of the phrase "immediate post-injury medical care" in subsection (h)(1), (2), and (4) when used in the same context as "emergency medical care." Commenter asserted that by definition in §180.1(11), a significant interim period of time may elapse between the actual date of injury and the "first date of medical attention," and further stated that only doctors on the ADL should be able to treat in situations other than "emergency care."

RESPONSE: The commission disagrees with the recommendation to delete the phrase "immediate post-injury medical care." Section 408.023(f) of the Act provides an exception from the ADL requirement for a doctor performing immediate post-injury medical care and specifically authorizes the commission to define this term. The definition for "immediate post-injury medical care" set out in §180.1(11), and is limited to health care provided on the date that the employee first seeks medical attention.

Subsection (h)(2)

COMMENT: Commenter recommended adding the following language to subsection (h)(2), "A doctor is entitled to reimbursement in accordance with the doctor's level of Certificate of Registration 'or granted exception status' and the Statute and Rules...." The commenter indicated the addition of the exception status will allow the carrier to verify via the commission's website that the provider who is not on the ADL could be reimbursed on an initial audit of the bill by the carrier.

RESPONSE: The commission disagrees that the recommended language addition is needed. Subsection (h)(2)(B) provides that a doctor who has been granted a temporary exception is entitled to reimbursement. The commission's website will provide any active commission list(s) (e.g., ADL, DDL, IR/MMI List, etc.) including any temporary exception status that a doctor may have. Carriers and other system participants will be able to download the reports that the system provides related to this information from the commission's website.

Subsection (h)(3)

COMMENT: Commenter requested clarification as to how an insurance carrier will know the level of a doctor's certificate of registration? Commenter implied the interpretation of §180.20 (h)(2) is that the amount of reimbursement is different depending on the doctor's certificate of registration level.

RESPONSE: The commission disagrees. The amount of reimbursement to a doctor for a particular service is not different for different levels of certification, but whether the doctor is eligible for reimbursement for a service can depend on the doctor's Certificate of Registration level. Carriers and other system participants will be able to determine the level of Certification for a doctor from the commission's website.

COMMENT: Commenter recommended deleting all of subsection (h)(3)(C) because, as per §133.304, the insurance carrier should be responsible for providing a full audit of the billed charges only after validation of the providers' entitlement to reimbursement have been established. Commenter recommended deleting in subsection (h)(3)(D), the sentence "Within 14 days of receipt of notice that the doctor has been granted an exception, the carrier shall remit payment." Commenter further recommended replacing it with the sentence, "A provider that has been granted an exception must file a request for reconsideration with the carrier as outlined in §133.304. The carrier shall process the request for reconsideration in accordance with §133.304." Commenter stated this would require less tracking of the process by the carrier and the Commission. Commenter recommended the following language change to subsection (h)(3)(E), "The doctor shall be entitled to interest as outlined in §133.304." Commenter additionally recommended deleting the reference to the carrier remitting payment within 14 days of receipt of notice that the doctor has been granted an exception. Commenter indicated the carrier should not have to create another process for tracking reimbursement of bills separate from those processes outlined in §133.304.

RESPONSE: The commission agrees in part. The commission agrees that carriers should not have to create another process for tracking reimbursement of bills separate from those processes outlined in §133.304. The commission also agrees with the suggested deletions, and has deleted all of proposed subparagraphs (h)(3)(A - E). Subsection (h)(3) has been changed to clarify that a doctor is entitled to reimbursement based on the doctor being on the ADL or granted a temporary exception to the requirement to be on the ADL at the time the service was provided. Subsection (h)(4) has been changed to clarify how carriers should process bills from doctors who do not appear on the commission's list of doctors eligible (by virtue of their certification or exception) to receive reimbursement. Beginning on September 1, 2003, doctors who are not on the ADL or granted an exception by the commission to be on the ADL, at the time a service is provided will not be entitled to reimbursement for those services. The commission disagrees with the recommended replacement language to subparagraphs (h)(3)(D) and (E) because such language replacement would allow reimbursement for services provided while a doctor was not on the ADL or approved for exception to this requirement. A bill submitted by a doctor who is not entitled to reimbursement because the doctor does not meet the requirements of subsection (h)(2), will not require the carrier to further review the bill, but instead requires the carrier to deny the bill with the appropriate payment exception code. If the doctor can show that he/she was eligible to receive reimbursement, the doctor can ask for reconsideration of the denial and provide additional documentation. The submission of an application for the Approved Doctor List (ADL) does not establish the doctor's approval to be on the ADL, nor does the submission of an application entitle the doctor to reimbursement for treatments or services provided. The commission must review an application and provide a doctor with approval as indicated by a Certificate of Registration or an exception. Commission approval must have been granted at the time the service is performed for the doctor to be entitled to reimbursement for that service.

Subsection (i)

COMMENT: Commenter recommended that all information on the commission's website should be available for download, including information relating to ADL exception and the effective dates for each provider's ADL status. Commenter stated that knowing the effective date of a provider's status is important to the insurance carrier to audit the provider's charges correctly, and to track the reason for denial and/or subsequent reimbursement of the provider's charges. Carriers must be able to obtain ADL information in a format that can be integrated with the carrier's bill processing system.

RESPONSE: The commission agrees and has developed a data report that can be easily downloaded from the website and will contain all necessary information pertaining to each doctor's list status or temporary exception status, effective dates, and other important details. This data can be used to develop programs to interface the commission's data with external customers' systems. The report can be found by accessing the TXCOMP site and selecting the reports menu available to all system participants.

Subsection (k)

COMMENT: Commenter recommended deleting the term "agreement" in subsection (k), or adding language to define what exceptions warrant an "agreement." Commenter's assertion is that the term "agreement" is not defined and does not indicate who the parties to an agreement are.

RESPONSE: The commission agrees that the term should not be used in these rules, but for a reason other than the one given by the commenter. Use of the term in these rules is confusing given the statutory definition of agreement in §401.011(3) of the Act. Therefore, the commission has deleted the terms "agreement or" from subsection (k) of the amended rule, and replaced the language with, "agreed settlement pursuant to §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or Texas Government Code §2001.056 (relating to Informal Disposition of Contested Case)."

Rule 180.21

COMMENT: Commenter supported the adoption of the proposed amendments to §180.21.

RESPONSE: The commission agrees that the amended rules are necessary changes to ensure access to quality health care as and when needed and access to evaluations of health care and income benefit eligibility.

Subsection (c)(5)

COMMENT: Commenter recommended adding that supplemental training shall be completed every two years (rather than between 18 and 30 months) from the date the doctor is certified as an approved doctor, or has passed the test required to obtain and retain full maximum medical improvement (MMI) / Impairment Rating (IR) authorization, and within 12 months following published updates or changes in the AMA Guides to the Evaluation of Permanent Impairment. Commenter's stated rationale for this recommendation is that the decrease in timeframe for completion of supplemental training ensures accurate, high quality, and currently relevant Designated Doctor MMI/IR examinations.

RESPONSE: The commission agrees in part with commenter's recommendation that re-education, testing and re-certification should occur within a reasonable timeframe following published update or changes in the AMA Guides to the Evaluation of Permanent Impairment (Guides). The commission disagrees with the deletion of the language requiring supplemental training to be completed between 18 and 30 months following the doctor's passing the test required to obtain and retain full MMI/IR authorization because the additional training needs to be done in a reasonable interval between testing dates. Additional training and testing every four years as required by the commission is well-within acceptable standards for re-certification. Most boards, for example, re-certify every seven to ten years.

Rule 180.23

COMMENT: Commenter supported the adoption of the proposed amendments to §180.23.

RESPONSE: The commission agrees that the amended rules are necessary changes to ensure access to quality health care as and when needed and access to evaluations of health care and income benefit eligibility.

Subsection (b)

COMMENT: Commenter opposed the language as proposed in subsection (b) because it does not give a doctor an incentive to complete all training and meet the requirements to be added to the ADL. Commenter stated the language provides incentive for doctors granted an exception to never meet the ADL training requirements, and that the Legislature never intended such an outcome when HB-2600 was passed.

RESPONSE: The commission disagrees. The amendments to subsection (b) clarify and strengthen the original intent of this subsection to allow individual exceptions to training and registration requirements that may be granted on a case-by-case basis to a doctor. This provision addresses access to care concerns. As an example, an injured employee who works out of state may seek treatment by a doctor from that state who is not on the ADL. In order to assure access to medically necessary health care for that injured employee, the commission may grant that out of state doctor an exception from certain training and registration requirements for the provision of services to that specific injured employee. The commission will monitor these exceptions as they are granted on a case-by-case basis. A temporary exception to the requirement to be on the ADL necessitates the doctor to successfully complete the training, application and financial disclosure required of all applicants.

COMMENT: Commenter recommended adding language of an example to subsection (b), and suggested the subsection be changed to read, "The exemption shall be considered temporary, shall have specific effective dates, and indicate any specifics of the exception, such as whether it is for a specific injured worker."

RESPONSE: The commission disagrees that recommended language is necessary. Most of the suggested additional information is already designed to be made available online to all concerned system participants. For case-by-case exceptions granted, subsection (b) provides that the commission will provide a copy of the approval to the carrier. The commission has developed a data report that can be easily downloaded from the website that will contain all necessary information pertaining to each doctor's list status or temporary exception status, effective dates, and other important details. This data can be used to develop programs to interface the commission's data with external customers' systems. The report can be found by accessing the TXCOMP site and selecting the reports menu available to all system participants.

Subsection (c)(1)(A)

COMMENT: Commenter recommended deletion of the phrase in subsection (c)(1)(A), "immediate post-injury medical care" when used in the same context as "emergency medical care." Commenter asserted that by definition in §180.1(11), a significant interim period of time may elapse between the actual date of injury and the "first date of medical attention," and further stated that only doctors on the ADL should be able to treat in situations other than "emergency care."

RESPONSE: The commission disagrees with the recommendation to delete the phrase "immediate post-injury medical care." Section 408.023(f) of the Act provides an exception from the ADL requirement for a doctor performing immediate post-injury medical care and specifically authorizes the commission to define this term. The definition for "immediate post-injury medical care" set out in §180.1(11), and is limited to health care provided on the date that the employee first seeks medical attention.

Subsection (c)(1)(D)

COMMENT: Commenter recommended deleting the last sentence of subsection (c)(1)(D). The commenter stated that deletion of the sentence would remove the restriction of Non-Medical Management (NMM) providers from participating in a regional network or performing utilization and/or peer review functions. Commenter further stated these types of providers (NMM) are necessary to the medical treatment of injured employees and should be available within regional network, and for performing UR/PR functions because their skill and experience should be considered valuable.

RESPONSE: The commission agrees in part. Doctors wishing to participate in a regional network within the workers' compensation system should be allowed to do so as an NMM doctor and according to the limitations of that designation and the adopted rule has been revised from the rule as proposed, to allow this. The commission disagrees that a doctor with an NMM designation should be permitted to perform utilization review and/or peer review. Doctors who perform any utilization review or peer review functions, including reviews for independent review organizations, are required to participate in the system as an ADL Level 1 or 2 doctor, and not request distinction as an NMM. The commission's training modules provide the doctor with the necessary tools for such endeavors.

In reviewing this comment, the commission determined revision of §180.23(c)(1)(B) is appropriate to clarify that doctors with a Level 1 Certificate of Registration may perform any utilization review or peer review functions, not just those requested by carriers. The rule has been amended to reflect these changes.

Subsection (h)

COMMENT: Commenter recommended a revision to subsection (h) to read, "ADL approval requires a doctor to successfully complete commission prescribed training prior to admission and renewal." Commenter further recommended deleting the phrases "at a minimum," and "continued approval status at a minimum requires a doctor to successfully complete follow up training as required." Commenter stated that the phrase "at a minimum" implies that the requirements are minimum standards when additional requirements are stated in §180.20.

RESPONSE: The commission disagrees. The terms "at a minimum" as used in the amended rule, are used to establish baseline requirements for required training. While section 180.23 is specifically related to training requirements, and additional requirements are addressed in §180.20.

In reviewing the comment related to subsection (h), the commission determined revision of §180.23(h)(4) is appropriate to clarify that the terms "agreement or" should not be used in §180.20(k) and §180.23(h)(4). Use of the terminology in these two rules is confusing given the statutory definition of agreement in §401.011(3) of the Act. Therefore, the commission has deleted the terms "agreement or" from subsection (h)(4) of this amended rule and has further amended subsection (h)(4) to reflect the replacement language, "agreed settlement pursuant to §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or Texas Government Code §2001.056 (relating to Informal Disposition of Contested Case)."

The amended rules are adopted pursuant to: the Texas Labor Code, §401.011 which contains definitions used in the Texas Workers' Compensation Act; the Texas Labor Code, §401.024, which provides the commission the authority to require use of facsimile or other electronic means to transmit information in the system; the Texas Labor Code, §402.042, which authorizes the Executive Director to enter orders as authorized by the Act as well as to prescribe the form and manner and procedure for transmission of information to the commission; the Texas Labor Code, §402.061, which authorizes the commission to adopt rules necessary to administer the Act; the Texas Labor Code, §406.010, which authorizes the commission to adopt rules regarding claims service; the Texas Labor Code, §408.021, which states an employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed; the Texas Labor Code, §408.022, which address choice of treating doctor; the Texas Labor Code, §408.023, which requires the commission to develop a list of approved doctors and lay out the requirements for being on the list and which grants the commission the authority to provide for exceptions to the requirement to be on the ADL, as necessary to ensure that employees have access to health care; the Texas Labor Code, §408.0231, which provides the commission with the responsibility for maintenance of the list, with the authority for imposing sanctions, and requires the commission to adopt rules; the Texas Labor Code, §408.025 which requires the commission to specify by rule what reports a health care provider is required to file; the Texas Labor Code, §413.002, which requires the commission to monitor health care providers and carriers to ensure compliance with commission rules relating to health care including medical policies and fee guidelines; the Texas Labor Code, §413.011, which requires the commission by rule to establish medical policies relating to necessary treatments for injuries and designed to ensure the quality of medical care and to achieve effective medical cost control; the Texas Labor Code, §413.012, which requires the commission to review and revise medical policies and fee guidelines at least every two years to reflect current medical treatment and fees that are reasonable and necessary; the Texas Labor Code, §413.013, which requires the commission by rule to establish a program for prospective, concurrent, and retrospective review and resolution of a dispute regarding health care treatments and services; a program for the systematic monitoring of the necessity of the treatments administered and fees charged and paid for medical treatments or services including the authorization of prospective, concurrent or retrospective review and a program to detect practices and patterns by insurance carriers in unreasonably denying authorization of payment for medical services, and a program to increase the intensity of review; the Texas Labor Code, §413.014, which requires the commission to specify by rule, except for treatments and services required to treat a medical emergency, which health care treatments and services require express preauthorization and concurrent review by the carrier as well as allowing health care providers to request precertification and allowing the carriers to enter agreements to pay for treatments and services that do not require preauthorization or concurrent review. This mandate also states the carrier is not liable for the cost of the specified treatments and services unless preauthorization is sought by the claimant or health care provider and either obtained or ordered by the commission; the Texas Labor Code, §413.017, which establishes medical services to be presumed reasonable when provided subject to prospective, concurrent review and are authorized by the carrier; the Texas Labor Code, §413.031, which establishes the right to access medical dispute resolution; the Texas Labor Code, §413.041, which requires financial disclosure of financial interests by health care providers and their employers, which requires the commission to adopt federal standards prohibiting payment of acceptance of payment in exchange for health care referrals, and which prohibits payment to a provider during a period of noncompliance with disclosure requirements; the Texas Labor Code, §413.0511, which creates the position of Medical Advisor and imbues the position with certain responsibilities and authority; the Texas Labor Code, §413.0512, which creates the Medical Quality Review Panel (MQRP) and grants it certain responsibilities and authority; certain responsibilities and authority; the Texas Labor Code §413.0513, which lays out confidentiality provisions relating to the MQRP; the Texas Labor Code, §414.007, which allows the review of referrals from the Medical Review Division by the Division of Compliance and Practices; and; the Texas Labor Code, §415.0035, which establishes administrative violations for repeated administrative violations.

The rule amendments are adopted pursuant to: the Texas Labor Code, §401.011, §401.024, §402.042, §402.061, §406.010, §408.021 - 408.023, §408.0231, §408.025, §13.002, §§413.011 - 413.014, §413.017, §413.031, §413.041, §§413.0511 - 413.0513, §414.007, and §415.0035.

§180.20.Commission Approved Doctor List.

(a) This section governs the commission's approved doctor list (ADL). Except in an emergency, as defined in §133.1 of this title (relating to Definitions For Chapter 133) or for the immediate post-injury medical care, as defined in §180.1 of this title (relating to Definitions) injured employees (employees) shall receive health care from a doctor on the ADL:

(1) The ADL established by the statute and commission rules as it exists on August 31, 2003 is null and void as of September 1, 2003. Any doctor on the ADL prior to September 1, 2003 who does not reapply to be on the ADL or whose application is not approved will not be on the ADL as of September 1, 2003.

(2) On or after September 1, 2003, doctors who provide any functions in the Texas workers' compensation system are required to be on the ADL.

(b) Until September 1, 2003, unless deleted from the list by the commission, the ADL 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. Doctors licensed in other jurisdictions may ask to be added to the list by submitting a written request containing information prescribed by the commission. Doctors on the ADL on or after September 1, 2003, whether licensed in Texas or licensed by another jurisdiction, shall have:

(1) successfully completed the training required by §180.23(h) of this title (relating to Commission Required Training for Doctors/Certificate of Registration Levels);

(2) applied for a Certificate of Registration with the commission in the form and manner prescribed by the commission; and

(3) disclosed financial interests as required by Texas Labor Code §413.041 and §180.24 of this title (relating to Financial Disclosure) with the application.

(c) An incomplete application for registration to be admitted to the ADL pursuant to this section shall be rejected and shall not be processed. A complete application shall include:

(1) general contact information including, but not limited to: name, mailing address, voice and facsimile numbers, and an email address;

(2) the training module taken and date completed;

(3) Impairment Rating Skills Examination score, if applicable;

(4) verification of licensure;

(5) disciplinary actions or practice restrictions by an appropriate licensing or certification authority, if any;

(6) an agreement that the doctor will comply with the Statute and Rules, including but not limited to, cooperating with commission monitoring and review efforts such as audits by the commission and paying audit bills when required by Statute or Rule;

(7) if the doctor applying for the ADL is not licensed in this state but wishes to perform utilization review and/or peer reviews for an insurance carrier or its agent, the applicant must certify that the reviews will be performed under the direction of a doctor who is licensed in this state and has an ADL Level 2 Certificate of Registration (as provided in §180.23 of this title). The carrier requesting such a review must ensure that the work was performed under the direction of an appropriate in-state doctor, and, upon request, must identify the in-state doctor and present documentation that the review was performed under the direction of that doctor; and

(8) if the doctor is applying for a Level 1 Certificate of Registration with a Non-Medical Management designation as provided in §180.23(c)(1)(D) of this title, the doctor must indicate in the appropriate place on the application that the doctor's practice does not include ongoing medical management, including pain management, of injured employees.

(d) The commission may utilize members of the Medical Quality Review Panel for evaluating ADL applications and making recommendations to the Medical Advisor to approve, approve with condition(s) or restriction(s), or deny admission to the ADL.

(e) The commission may grant a temporary exception to the requirement to be on the ADL to ensure that employees have access to health care pending commission action on a doctor's application. A doctor with a temporary exception must meet all the requirements that doctors on the ADL must meet. A temporary exception does not constitute "being on the ADL," "approval to be on the ADL," or "denial of an application to be on the ADL."

(f) Doctors shall be denied admission to the ADL or admitted with condition(s) or restriction(s) for:

(1) failing to complete required training;

(2) having relevant restriction(s) on their practice (including, but not limited to, prior deletion from the ADL); or

(3) other activities which warrant application denial or restriction such as grounds that would require or allow the Medical Advisor to recommend deletion of a doctor from the ADL or other sanction of a doctor as specified in §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or the Statute and Rules.

(g) The commission shall notify a doctor of the commission's approval or denial of the doctor's application to the ADL.

(1) Denials or approvals with condition(s) or restriction(s) shall include the reason(s) for the action.

(2) Within 14 days after receiving the notice, the doctor may file a response, which addresses the reasons given for the denial or admission with restriction(s).

(A) If a response is not received by the 15th day after the date the doctor received the notice, the action shall be final and no further notice shall be sent.

(B) If a response which disagrees with the action is timely received, the commission shall review the response and shall notify the doctor of the commission's final decision. If the final decision is not an unrestricted approval, the commission's final notice shall explain the reason why the doctor's response did not convince the commission to grant the doctor an unrestricted admission to the ADL.

(3) All notices under this subsection shall be delivered by a verifiable means.

(4) The fact that the commission did not take action to deny admission to a doctor or admit a doctor with condition(s) or restriction(s) to the ADL does not waive the commission's right to review or further review a doctor and take action at a later date.

(h) Chapter 133 of this title (relating to Benefits - Medical Benefits) applies to all medical bills, including those from doctors who were not on the ADL at the time the health care was rendered.

(1) All licensed doctors, whether on the ADL or not, are entitled to reimbursement in accordance with the Statute and Rules for providing reasonable and necessary emergency or immediate post-injury medical care.

(2) A doctor is entitled to reimbursement in accordance with the doctor's level of Certificate of Registration and the Statute and Rules for directly or indirectly providing reasonable and necessary health care (other than emergency or immediate post-injury medical care) or other medical services (such as peer reviews or other evaluations) if:

(A) the doctor was on the ADL at the time the service was provided;

(B) the doctor was granted a temporary exception to the requirement to be on the ADL at the time the service was provided; or

(C) the doctor has been granted an exception on a case-by-case basis as provided in §180.23(b) of this title, and the claim for which the doctor is billing is one for which the doctor has been granted an exception.

(3) A doctor who is entitled to reimbursement based on paragraph (2)(A) and (B) of this subsection may perform medical services and bill for those services only after notification of such entitlement from the commission.

(4) A carrier who receives a bill from a doctor who is not entitled to reimbursement pursuant to paragraph (2) of this subsection shall deny the medical bill and send the required explanation of benefits (EOB) with the appropriate payment exception code.

(5) Notwithstanding this subsection, a doctor's entitlement to direct or indirect reimbursement for health care or medical opinions directly or indirectly provided (other than for emergency or immediate post-injury medical care) may be limited by sanction imposed by the commission.

(i) The commission shall make available through its Internet website the names, licensure and other identification information, and ADL or ADL exception status of:

(1) doctors who are not on the ADL because their applications were denied;

(2) doctors on the ADL (including a description of any privileges, conditions or restrictions placed on the doctor by the commission);

(3) doctors deleted or suspended from the ADL or otherwise sanctioned by the commission (including a description of the sanction);

(4) doctors reinstated to the ADL or whose sanctions were lifted by the commission; and

(5) doctors granted a temporary exception from the requirement to be on the ADL pursuant to subsection (e) of this section or on a case-by-case basis.

(j) Doctors who are on the ADL or who have applied to be on the ADL shall provide the commission with updated information within 30 days of a change in any of the information provided to the commission on the doctor's ADL application.

(k) Level 1 Certificates of Registration are valid for two years from date of issuance, and Level 2 Certificates of Registration are valid for four years from date of issuance unless the Certificate provides otherwise, the date is revised by agreed settlement pursuant to §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or Texas Government Code §2001.056 (relating to Informal Disposition of Contested Case), Commission order or decision, or the doctor has been removed from the ADL. Upon expiration of a doctor's Certificate of Registration, the doctor must reapply for the ADL.

§180.21.Commission Designated Doctor List.

(a) In order to serve as a designated doctor, a doctor must be on the Designated Doctor List (DDL).

(b) To be on the DDL prior to September 1, 2003, the doctor shall at a minimum:

(1) be currently active on the Approved Doctor List (ADL) as set forth in Texas Labor Code §408.023 and §180.20 of this title (relating to Commission Approved Doctor List);

(2) have maintained for the past three years and continue to maintain an active practice;

(3) have filed a request to be on the DDL in the form and manner prescribed by the commission and been approved by the commission; and

(4) meet the following training requirements:

(A) have successfully completed commission-approved training in the proper use of the AMA Guides prior to submission of an application;

(B) have successfully completed commission-approved training at least every two years from the date of the last training; and

(C) have passed the commission-approved written examination for impairment rating training within the timeframe specified by the commission.

(c) To be on the DDL on or after September 1, 2003, the doctor shall at a minimum:

(1) be currently active on the ADL with a Level 2 Certificate of Registration with no condition(s) or restriction(s), or have a temporary exception to the requirement to be on the ADL, as set forth in Texas Labor Code §408.023 and §180.20 of this title;

(2) have had an active practice for one year during their career;

(3) be fully authorized to assign impairment ratings and certify maximum medical improvement (MMI) under §180.23(i) of this title (relating to Commission Required Training for Doctors/Certificate of Registration Levels);

(4) have filed a request in the form and manner prescribed by the commission, and have been approved by the commission to be included on the DDL; and

(5) either maintain an active practice or successfully complete commission-approved supplemental training on medical issues relevant to workers' compensation and/or serving as a designated doctor. Supplemental training shall be completed between 18 and 30 months following the doctor's passing the test required to obtain and retain full MMI/impairment authorization.

(d) An incomplete application for registration to be admitted to the DDL pursuant to this section and other Rules shall be rejected and shall not be processed. A complete application shall include:

(1) general contact information including, but not limited to: name, mailing address, voice and facsimile numbers and an email address;

(2) the training certificate indicating the level of training completed;

(3) Impairment Rating Skills Examination score;

(4) verification of licensure;

(5) information on the doctor's training and experience in various types of health care and injury areas; and

(6) disciplinary actions or practice restrictions by an appropriate licensing or certification authority, if any.

(e) The commission may utilize members of the Medical Quality Review Panel (MQRP) for evaluating DDL applications and making recommendations to the Medical Advisor to approve or deny admission to the DDL. The commission may also utilize members of the MQRP regarding deletion, suspension, or other sanction of a designated doctor as provided in this section.

(f) Doctors shall be denied admission to the DDL:

(1) if the doctor does not meet the requirements of subsection (c)(1) of this section;

(2) if the doctor has not completed required training in accordance with §180.23(i) of this title and passed the commission approved test;

(3) for failing to submit a complete application in accordance with this section;

(4) for having a relevant restriction on their practice (including, but not limited to, prior deletion from the ADL or DDL or a prior ADL restriction); or

(5) for other activities which warrant application denial such as grounds that would require the Medical Advisor to recommend deletion of a doctor from the ADL or other sanction of a doctor as specified in §180.26 of this Title (relating to Doctor and Insurance Carrier Sanctions) or the Statute and Rules.

(g) The commission shall notify a doctor of the commission's approval or denial of the doctor's application to the DDL.

(1) Denials shall include the reason(s) for the denial.

(2) Within 14 days after receiving the notice, the doctor may file a response which addresses the reasons given for the denial.

(A) If a response is not received by the 15th day after the date the doctor received the notice, the denial shall be final and no further notice shall be sent.

(B) If a response which disagrees with the denial is timely received, the commission shall review the response and shall notify the doctor of the commission's final decision. If the final decision is a denial, the commission's final notice shall explain the reason why the doctor's response did not convince the commission to admit the doctor to the DDL.

(3) All notices under this subsection shall be delivered by a verifiable means.

(4) The fact that the commission did not take action to deny or restrict admission to the DDL does not waive the commission's right to review or further review a doctor and take action at a later date.

(h) When necessary because the injured employee is temporarily located or is residing out-of-state, the commission may waive any of the requirements as specified in this rule for an out-of-state doctor to serve as a designated doctor to facilitate a timely resolution of the dispute.

(i) Doctors on the DDL shall provide the commission with updated information within 30 days of a change in any of the information provided to the commission on the doctor's DDL application.

(j) In addition to the grounds for deletion or suspension from the ADL or for issuing other sanctions against a doctor under §180.26 (of this title), the commission shall delete or suspend a doctor from the DDL, or otherwise sanction a designated doctor for noncompliance with requirements of this section or any of the following:

(1) four refusals within a 90-day period, or four consecutive refusals to perform within the required time frames, a commission requested appointment for which the doctor is qualified;

(2) misrepresentation or omission of pertinent facts in medical evaluation and narrative reports;

(3) having a pattern of practice of unnecessary referrals to other health care providers for the assignment of an impairment rating or determination of MMI;

(4) submission of inaccurate or inappropriate reports as a pattern of practice due to insufficient examination and analysis of medical records;

(5) willful failure to timely respond to a request for clarification from the commission regarding an examination or failure to timely respond as a pattern of practice;

(6) assignments of MMI and/or impairment ratings overturned in a contested case hearing, appeals panel decision and/or court decision;

(7) any of the factors listed in subsection (f) of this section that would allow for denial of admission to the DDL;

(8) failure to timely successfully complete training and testing requirements as specified in subsections (b) or (c) of this section;

(9) failure to notify the commission field office of any disqualifying association within 48 hours of receiving notice of being selected as a designated doctor as a pattern of practice or conducting an examination when there is a disqualifying association;

(10) failure to maintain an active practice or failure to maintain the alternate training requirements outlined in subsection (c)(5) of this section;

(11) self-referring for treatment or becoming the employee's treating doctor for the medical condition evaluated by the designated doctor; or

(12) other significant violation of Statute and/or Rules while serving as a designated doctor.

(k) The process for notification and opportunity for appeal of a sanction is governed by §180.27 of this title (relating to Sanctions Process/Appeals) except that suspension, deletion, or other sanction relating to the DDL shall be in effect during the pendency of any appeal.

(l) The commission shall make available through its Internet website the names of:

(1) doctors on the DDL;

(2) doctors deleted or suspended from the list or otherwise sanctioned by the commission (including a description of the sanction); and

(3) doctors reinstated to the list or whose sanctions were lifted by the commission.

(m) When a doctor is added to the DDL or readmitted following a suspension or deletion, the doctor shall be placed at the bottom of the list for rotation purposes under Texas Labor Code §408.0041.

(n) The following definitions apply to this section:

(1) Active practice - a doctor has an active practice if the doctor maintains routine office hours of at least 20 hours per week for the treatment of patients.

(2) Disqualifying Association - any association which may reasonably be perceived as having potential to influence the conduct or decision of the designated doctor.

(A) A disqualifying association between a designated doctor and a party may include:

(i) receipt of income, compensation, or payment of any kind not related to health care provided by the doctor;

(ii) shared investment or ownership interest;

(iii) contracts or agreements that provide incentives, such as referral fees, payments based on volume or value, and waiver of beneficiary coinsurance and deductible amounts;

(iv) contracts or agreements for space or equipment rentals, personnel services, management contracts, referral services, or warranties, or any other services related to the management of the doctor's practice;

(v) personal or family relationships; or

(vi) any other financial arrangement that would require disclosure under §180.24 of this title (relating to Financial Disclosure).

(B) Receipt of normal payments rendered for services provided pursuant to managed care/preferred provider contracts, or any payment in accordance with the Texas Workers' Compensation Act and rules, is not a disqualifying association.

(3) Party - any of the following entities including any of their agents or representatives: the insurance carrier, health care provider (including designated doctor and treating doctor), injured employee, or employer.

(4) Self-Refer - treatment by the designated doctor or referral for treatment to another health care provider with which the designated doctor has a disqualifying association.

§180.23.Commission Required Training for Doctors/Certificate of Registration Levels.

(a) This section identifies the training requirements for doctors to be approved to provide various services within the Texas workers' compensation system.

(b) The commission, in order to ensure that injured employees (employees) have access to health care and insurance carriers (carriers) have access to evaluations of an employee's health care and income benefit eligibility, may grant a doctor exceptions to certain training and registration requirements and may allow a doctor to perform functions not normally permitted by the doctor's Level of Certificate of Registration. Such exceptions may be granted on a per request, per case basis. When an exception is granted on a per request, per case basis, the commission shall provide a copy of the approval to the carrier.

(c) Doctors on the approved doctor list (ADL) shall have a Level 1 or Level 2 Certificate of Registration.

(1) A Level 1 Certificate of Registration allows a doctor to:

(A) infrequently provide health care to employees (providing care, other than emergency or immediate post-injury medical care, to 18 Texas workers' compensation claimants or fewer per calendar year);

(B) perform utilization review or peer review functions;

(C) participate in a regional network established under Texas Labor Code §408.0221; and/or

(D) provide medical services to an unlimited number of Texas workers' compensation claimants if the doctor's medical practice is Anesthesiology - Surgical Only (excludes pain management), Radiology, or Pathology and does not, by nature, include ongoing medical management of injured employees, and the doctor requests a Non-Medical Management designation. However, this designation does not allow the doctor to perform any of the functions listed in subparagraph (B) of this paragraph.

(2) A Level 2 Certificate of Registration allows a doctor to serve in any role authorized in the Texas workers' compensation system with the exception of serving as a designated doctor unless the doctor is also on the designated doctor list which is governed by §180.21 of this title (relating to the Commission Designated Doctor List).

(d) A doctor seeking admission to the ADL shall receive training from the commission and/or a commission-approved trainer.

(e) A person or organization seeking to become a commission-approved trainer shall apply for approval in the form and manner prescribed by the commission.

(f) For each doctor trained, the commission-approved trainer shall file or provide the doctor's training information in the form and manner prescribed by the commission.

(g) Notwithstanding any other subsection of this section:

(1) a doctor not licensed in this state shall not perform utilization reviews and/or peer reviews for an insurance carrier or its agent unless the doctor performs the reviews under the direction of a doctor who:

(A) is licensed in this state,

(B) is on the ADL with a Level 2 Certificate of Registration, and

(C) has agreed to direct the doctor's reviews; and

(2) the commission may restrict or reduce a doctor's privileges or authorizations as provided in the Statute or Rules.

(h) ADL approval at a minimum requires a doctor to successfully complete commission-prescribed training prior to admission and renewal at a minimum requires a doctor to successfully complete follow-up training as required.

(1) Required training shall focus on the requirements of the Texas workers' compensation system with an emphasis on return to work, efficient utilization of care, entitlement to benefits, maximum medical improvement (MMI), and the determination of the existence of permanent impairment.

(2) Training may be completed through either self-study/distance learning (including online) or by attending training in person, as available.

(3) Application for a Level 1 Certificate of Registration requires completing the Limited Participation Doctor Training Module or other training as prescribed by the Commission in the application form. Application for a Level 2 Certificate of Registration requires completing the Doctor Training Module.

(4) Renewal of a Level 1 Certificate of Registration requires follow-up training every two years and renewal of a Level 2 Certificate of Registration requires follow-up training every four years unless the Certificate provides otherwise, the date is revised by agreed settlement pursuant to §180.26 of this title (relating to Doctor and Insurance Carrier Sanctions) or Texas Government Code §2001.056 (relating to Informal Disposition of Contested Case), Commission order or decision, or the doctor has been removed from the ADL. Follow-up training will serve as a refresher course but emphasize relevant changes in the Statute and Rules.

(i) This subsection governs authorization relating to certification of MMI, determination of permanent impairment, and assignment of impairment ratings in the event that a doctor finds permanent impairment exists when the examination of the employee occurs on or after September 1, 2003.

(1) Any doctor on the ADL, or who has been granted a temporary exception to be on the ADL pursuant to §180.20(e) or on a case-by-case basis, is authorized to determine whether an employee has permanent impairment resulting from a compensable injury. If the doctor finds that the employee does not have permanent impairment, the doctor is also authorized to certify the employee as reaching MMI.

(2) Full authorization to assign an impairment rating and certify MMI in an instance where the employee is found to have permanent impairment requires a doctor to receive commission certification by successfully completing the commission-prescribed Impairment Rating Training Module and passing the test. To remain certified, a doctor is required to successfully complete follow-up training and testing every four years.

(3) A doctor who has not completed the commission-prescribed training under subsection (i)(2) of this section but who has had similar training in the AMA Guides from a commission-approved vendor within the prior two years may submit the syllabus and training materials from that course to the commission for review. If the commission determines that the training is substantially the same as the commission-prescribed training and the doctor passes the commission-prescribed test, the doctor is fully authorized under this subsection. The ability to substitute training only applies to the initial training requirement, not the follow-up training.

(4) Notwithstanding any other provision of this subsection, a doctor who has not successfully completed training and testing required by this subsection for authorization to assign impairment ratings and certify MMI when there is permanent impairment may receive permission by exception to do so from the commission on a specific case basis.

(5) Full authorization under this section is one of the minimum requirements to be on the Designated Doctor List (DDL). Section 180.21 of this title governs DDL membership requirements and procedures.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 16, 2003.

TRD-200303045

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: June 5, 2003

Proposal publication date: March 14, 2003

For further information, please call: (512) 804-4287