TITLE 28.INSURANCE

Part 2. TEXAS WORKERS' COMPENSATION COMMISSION

Chapter 102. PRACTICES AND PROCEDURES--GENERAL PROVISIONS

28 TAC §§102.3 - 102.5

The Texas Workers' Compensation Commission (the commission) proposes amendments to §§102.3, 102.4, and 102.5 in Chapter 102, concerning Practices and Procedures--General Provisions. The amendments are proposed to support the exchange of billing and reimbursement data, as well as electronic exchange of medical documentation in the workers' compensation system.

The Texas Register published text shows words proposed to be added to or deleted from the current text, and should be read to determine all proposed changes.

Currently, the majority of medical bills in the Texas workers' compensation system are submitted on paper forms to insurance carriers, third party administrators, or to medical bill review vendors. Minimal electronic billing occurs in the system. Insurance carriers report professional and hospital bill payment data to the commission in electronic file formats developed specifically for Texas workers' compensation. The commission does not currently collect pharmacy and dental data.

House Bill 2511 (HB 2511), passed in 1999 by the 76th Texas Legislature added Texas Labor Code §401.024 which allows the commission to adopt rules to permit or require electronic transmission in place of established forms, manners, or procedures that require paper processing. The proposed amendments are part of the commission's Electronic Billing and Reimbursement (eBill) project initiated to identify and implement an electronic billing solution for the Texas workers' compensation system. The eBill project is a component of the commission's Business Process Improvement (BPI) initiative; a coordinated set of projects that use technology to streamline agency processes to meet the goals set out in HB 2511.

Proposed amendments to Chapter 102, concerning Practices and Procedures--General Provisions, apply the provisions of that chapter to medical benefits; modify language to define electronic communication and electronic transmission; and include Claim and Medical Electronic Data Interchange (EDI) and electronic billing and reimbursement as electronic transmissions. Current rule language referencing the insurance carrier representative's physical mailbox is eliminated to support the transition to electronic mail communication under the BPI initiative.

Currently Chapters 124 through 139 are exempted from the provisions of §102.3, concerning Computation of Time. Proposed amendment to subsection 102.3(f) removes the reference to specific rules and states that if there is a conflict between this rule and provisions of another rule applicable to a specific type of benefit, the other rule prevails.

Proposed amendment to subsection (h) of §102.4, concerning General Rules for Non-Commission Communications, clarifies that the provision of (h)(2) refer to mail sent via the United States Postal Service regular mail. Subsection (k) is amended to expand the definition of written communication by including "submissions." Subsection (m) is amended to define electronic communications and electronic transmissions. This amendment is consistent with §401.024(a) of the Texas Workers' Compensation Act. Proposed new §102.4(p) establishes the date of receipt for non-commission communications. The current rule defines the term "sent date". Received date is important in medical bill submission and processing. Defining received date allows the commission to more effectively enforce current rules and proposed amendments.

Proposed amendments to subsection (d) of §102.5, concerning General Rules for Written Communications to and from the Commission, add the term "the earliest of" related to the received date for communications sent by mail and clarifies that the term mail applies to United States Postal Service regular mail. Amendments also remove language that references the insurance carrier Austin representative's physical mailbox at the commission's main office in Austin. This amendment allows the commission to implement use of an electronic mail box in place of the physical mailbox currently used by insurance carrier Austin representatives. Subsections (e) and (f) have been amended to be consistent with language in §102.4(m) and Texas Labor Code §401.024(a), which define electronic communication and electronic transmission. Amendments also include Claim and Medical Electronic Data Interchange (EDI) and electronic billing and reimbursement as electronic transmissions. Subsection (g) is amended to expand the definition of written communication by including "submissions." Subsection (h) is amended to define the meaning of electronic transmissions and is consistent with §401.024(a) of the Texas Workers' Compensation Act.

Stacey Jefferson, Director of the Business and Information Technology Services Division, has determined that for the first five-year period the proposed rule is in effect there will be no fiscal implication for state or local governments as a result of enforcing or administering the amended rules. Ms. Jefferson has determined that there will be no cost to the commission in enforcing or administering the amended rules.

Local government and state government as a covered regulated entity will be impacted in the same manner as described below in this preamble for persons and entities required to comply with the rules as amended.

Ms. Jefferson has also determined that for each year of the first five years the amended rules are in effect, the public benefit will be greater flexibility for system participants to exchange medical billing, reimbursement, and documentation data electronically.

Health care provider and insurance carriers should experience no direct economic impact from the requirement to comply with the proposed amendments.

Employers who purchase workers' compensation insurance should experience no direct economic impact from the requirement to comply with these proposed amendments because there is no additional administrative requirement for the employer.

There will be no economic costs to employees, as these amendments do not impose any requirements on injured employees.

There is no anticipated adverse economic impact on small businesses or micro-businesses as a result of these amendments. There will be no difference in anticipated costs of compliance for small and micro-businesses as compared to large businesses.

Comments on the proposed rule amendments must be received by 5:00 p.m., March 7, 2005. You may comment via the Internet by accessing the commission's website at www.twcc.state.tx.us and clicking on "Rules" then clicking on "Proposed Rules for Comment." This medium for commenting will help you organize your comments by rule chapter. You may also comment by emailing your comments to RuleComments@twcc.state.tx.us or by mailing or delivering your comments to Linda Velasquez at the Office of the General Counsel, Mailstop #4-D, Texas Workers' Compensation Commission, 7551 Metro Center Drive, Suite 100, Austin, TX 78744.

Commenters are requested to clearly identify by number the specific rule and paragraph (e.g., 102.3(a)(1), 102.4(m), 102.5, etc.) commented upon. The commission may not be able to respond to comments that cannot be linked to a particular proposed rule. Along with your comment, it is suggested that you include the reasoning for the comment in order for commission staff to fully evaluate your recommendations.

Based upon various considerations, including comments received and the staff's or commissioners' review of those comments, or based upon the commissioners' action at the public meeting, the rule as adopted may be revised from the rule as proposed in whole or in part.

A public hearing on this proposal will be held on February 17, 2005 at the Austin central office of the commission (7551 Metro Center Drive, Suite 100, Austin, Texas). Those persons interested in attending the public hearing should contact the Commission's Office of Executive Communications at (512) 804-4430 to confirm the date, time, and location of the public hearing for this proposal. The public hearing schedule will also be available on the commission's website at www.twcc.state.tx.us.

The amendments are proposed under the following statutes: 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 for the implementation and enforcement of the Texas Workers' Compensation Act; Texas Labor Code §413.008 which authorizes the commission to collect certain medical bill and payment information from the insurance carrier; and HB 2511, 76th Texas Legislature which sets goals for the reduction of paper communication requirements.

No other code, statute, or article is affected by this rule action.

§102.3.Computation of Time.

(a) Due dates and time periods under this Act shall be computed as follows:

(1) computing a period of days. In counting a period of time measured by days, the first day is excluded and the last day is included.

(2) computing a period of months. If a number of months is to be computed by counting the months from a particular day, the period ends on the same numerical day in the concluding month as the day of the month from which the computation is begun, unless there are not that many days in the concluding month, in which case the period ends on the last day of that month.

(3) unless otherwise specified, if the last day of any period is not a working day, the period is extended to include the next day that is a working day.

(b) A working day is any day, Monday-Friday, other than a national holiday as defined by Texas Government Code, §662.003(a) and the Friday after Thanksgiving Day, December 24th and December 26th. Use in this title of the term "day," rather than "working day" shall mean a calendar day.

(c) Normal business hours in the Texas workers' compensation system are 8:00 a.m. to 5:00 p.m. Central Standard Time with the exception of the Commission's El Paso field office whose normal business hours are 8:00 a.m. to 5:00 p.m. Mountain Standard Time.

(d) Any written or telephonic communications received other than during normal business hours on working days are considered received at the beginning of normal business hours on the next working day.

(e) Unless otherwise specified by rule, any written or telephonic communications required to be filed by a specified time will be considered timely only if received prior to the end of normal business hours on the last permissible day of filing.

(f) If there is a conflict between this rule and a specific provision of another rule that is applicable to a specific type of benefit, the other rule prevails. [ This section does not apply to the computation of periods of entitlement to benefits. (Periods of entitlement to benefits are computed in accordance with specific rules on benefits set forth in Chapters 124 through 139 of this title (relating to Carriers: Required Notices And Mode of Payment; Education and Training Of Ombudsman; General Provisions Applicable To All Benefits; Benefits--Calculation Of Average Weekly Wage; Income Benefits--Temporary Income Benefits; Impairment And Supplemental Income Benefits; Benefits-Lifetime Income Benefits; Death Benefits--Death And Burial Benefits; General Medical Provisions; Benefits-Guidelines For Medical Services, Charges, and Payments; And Benefits-Vocational Rehabilitation)). ]

§102.4.General Rules for Non-Commission Communications.

(a) All written communications to a claimant (who is either an employee, an employee's legal beneficiary, or a subclaimant) shall be sent to the most recent address or facsimile number supplied by the claimant. If an address has not been supplied by the claimant, the most recent address provided by the employer shall be used.

(b) After an insurance carrier, employer, or health care provider is notified in writing that a claimant is represented by an attorney or other representative, copies of all written communications related to the claim to the claimant shall thereafter be mailed or delivered to the representative as well as the claimant, unless the claimant requests delivery to the representative only.

(c) Insurance carriers shall provide a toll free telephone number for receipt of communication from claimants and/or their representatives with a sufficient quantity of lines to service their volume of business.

(d) Insurance carriers and health care providers shall provide telephone and facsimile numbers in sufficient quantity of lines to service the volume of business for receiving required verbal and written communications regarding workers' compensation claims.

(e) Insurance carriers must ensure effective and timely communication with claimants and other parties in the system. If a claimant is unable to communicate with a carrier due to a language barrier and the claimant is unable to provide a person who he or she trusts to serve as a translator, the carrier shall provide a means to translate except as needed for a Commission proceeding. The claimant shall not be required to contract with or otherwise employ a translator.

(f) When a claimant contacts a carrier and requests a response regarding their claim, the response shall be verbally provided or sent in writing by the carrier within five working days of receiving the request, unless the request is redundant or the response is duplicative of information previously provided.

(g) Insurance carriers shall employ or provide sufficient numbers of person, including adjusters appropriately licensed by the Texas Department of Insurance to meet their obligations under the Act and this title.

(h) Unless the great weight of evidence indicates otherwise, written communications shall be deemed to have been sent on:

(1) the date received, if sent by fax, personal delivery or electronic transmission or,

(2) the date postmarked if sent by mail via United States Postal Service regular mail , or, if the postmark date is unavailable, the later of the signature date on the written communication or the date it was received minus five days. If the date received minus five days is a Sunday or legal holiday, the date deemed sent shall be the next previous day which is not a Sunday or legal holiday.

(i) A carrier shall maintain adjuster's notes on activities and verbal communications involved with the administration of a claim, with the exception of privileged attorney-client communications. The adjuster's notes shall, at a minimum, include the date of the activity or communication, the identity of the carrier staff involved in the contact, the person contacted by or contacting the carrier and a summary of the activity or communication.

(j) An insurance carrier, employer or health care provider that receives a written communication related to a workers' compensation claim shall date stamp or otherwise annotate the document indicating the date the written communication was received.

(k) Written communications include all records, reports, notices, filings, submissions, and other information contained either on paper or in an electronic format.

(l) For purposes of this title, if a written communication is required to be filed with both the Commission and another person by the Act or Commission rules, the other person shall be presumed to have received the written communication on the date the Commission received its copy, unless the other person annotated the date of receipt as provided in subsection (j) of this section or the means of delivery of the communication was different. In this situation, the other person has the burden of proving that it did not receive or timely receive the written communication.

(m) Electronic communication [ transmission ] refers to the electronic transmission of claim or medical information. [ by means such as e-mail ] Electronic transmission is defined as transmission of information by facsimile, electronic mail, electronic data interchange, or any other similar method and does not include telephonic communication . Electronic communication for reporting purposes is [ or electronic filing as ] described in §102.5(e) of this chapter (relating to General Rules for Written Communications to and from the Commission), §124.2 of this title (relating to Carrier Reporting and Notification Requirements), and §134.802 of this title (relating to Insurance Carrier [ Carrier's Submission of ] Medical Electronic Data Interchange [ Bills ] to the Commission).

(n) If the Commission receives an allegation that a carrier or health care provider has failed to provide a sufficient number of toll-free telephone, toll telephone, or facsimile lines or that a carrier has not provided a sufficient number of adjusters as required by this section, unless the violation appears to be willful or intentional, the Commission will not issue a monetary penalty or other sanctions prior to:

(1) notifying the alleged violator of the allegation;

(2) affording the alleged violator the opportunity to either disprove the allegation or provide mitigating information; and

(3) if the violator is unable to disprove the allegation, issuing a written warning to the violator allowing a reasonable grace period of not less than 30 days to correct the noncompliance. The grace period may be less than 30 days if the noncompliance prevents the violator from fulfilling other obligations under this title.

(o) A violation as described in subsection (n) will be considered willful or intentional if the violator has been advised of complaints such that the violator knew or should have known that the number of toll-free telephone, toll telephone, facsimile lines, or adjusters was insufficient and the violator cannot establish that it made good faith efforts to correct the deficiency or if the violator otherwise exhibited willful or intentional conduct.

(p) For purposes of determining the date of receipt for non-commission written communications, unless the great weight of evidence indicates otherwise, the Commission shall deem the received date to be five days after the date mailed via United States Postal Service regular mail; or the date faxed or electronically transmitted.

§102.5.General Rules for Written Communications to and from the Commission.

(a) After the Commission is notified in writing that a claimant is represented by an attorney or other representative, all copies of written communications to the claimant shall thereafter be sent to the representative as well as the claimant, unless the claimant requests delivery to the representative only. However, copies of settlements, notices setting benefit review conferences and hearings, and orders of the Commission shall always be sent to the claimant regardless of representation status. All written communications to the claimant or claimant's representative will be sent to the most recent address or facsimile number supplied on either the employer's first report of injury, any verbal or written communication from the claimant, or any claim form filed by the carrier via written notice or electronic transmission.

(b) All written communications to persons other than carriers and claimants will be sent to the most recent address or fax number reported to the Commission by the intended recipient or, in the absence of an address or fax number supplied by the intended recipient, to an address or fax number identified by the Commission.

(c) Unless otherwise specified by rule, written communications required to be filed with the Commission should be sent to the local Commission field office managing the claim, however, written communications shall also be accepted at any Commission office.

(d) For purposes of determining the date of receipt for those written communications sent by the Commission which require the recipient to perform an action by a specific date after receipt, unless the great weight of evidence indicates otherwise, the Commission shall deem the received date to be the earliest of: five days after the date mailed via United States Postal Service regular mail ; the first working day after the date the written communication was placed in a carrier's Austin representative box [ located at the Commission's main office in Austin as indicated by the Commission's date stamp ]; or the date faxed or electronically transmitted.

(e) Electronic [ Electronically filed records or ] communications shall be filed or submitted in the format, form, and manner prescribed by the Commission. Electronic communication [ A record ] is considered filed [ when submitted electronically ] if on the date received, the record meets the required edit checks to insure data quality. Electronic communication is defined [ filing is different than "electronic transmission" as described ] in subsection (h) of this section, §102.4(m) of this chapter (relating to General Rules for Non-Commission Communications), and §134.802 of this title (relating to Insurance Carrier [ Carrier's Submission of ] Medical Electronic Data Interchange [ Bills ] to the Commission). Claim Electronic Data Interchange records filed pursuant to §124.2 of this title (relating to Carrier Reporting and Notification Requirements):

(1) which do not pass the required edit checks in accordance with the International Association of Industrial Accident Boards and Commissions (IAIABC) and Texas EDI Implementation Guides shall be rejected back to the trading partner. Rejected records are not considered received by the Commission and must be corrected and re-submitted. Rejected records must be re-submitted by the original due date to be considered timely filed;

(2) which are accepted but in which the Commission identifies errors shall be corrected and resubmitted, in accordance with the Texas EDI Implementation Guide, within 90 days of receipt of the notification of the acceptance with errors through the corresponding transaction acknowledgment.

(f) Unless the great weight of evidence indicates otherwise, written communications received by the Commission by means other than electronic filing described in subsection (e) of this section and §124.2 of this title, and §134.802 of this title (relating to Insurance Carrier [ Carrier's Submission of ] Medical Electronic Data Interchange [ Bills ] to the Commission) shall be deemed to have been sent on:

(1) the date received if sent by fax, personal delivery or electronic transmission or,

(2) the date postmarked if sent by United States Postal Service regular mail, or, if the postmark date is unavailable, the later of the signature date on the written communication or the date it was received minus five days. If the date received minus five days is a Sunday or legal holiday, the date deemed sent shall be the next previous day which is not a Sunday or legal holiday.

(g) Written communications include all records, reports, notices, filings, submissions, and other information contained either on paper or in an electronic format.

(h) Electronic transmission is defined as [ refers to ] transmission of information by [ means such as ] facsimile, electronic mail, [ e-mail ] electronic data interchange or any other similar method and does not include telephonic communication[ or electronic filing as described in subsection (e) of this section, §124.2 of this title and §134.802 of this title ].

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 24, 2005.

TRD-200500292

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Earliest possible date of adoption: March 6, 2005

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


Chapter 134. BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS

Subchapter I. PROVIDER BILLING PROCEDURES

28 TAC §134.800, §134.802

The Texas Workers' Compensation Commission (the commission) proposes amendments to §134.800 and §134.802 in Chapter 134, concerning Benefits--Guidelines for Medical Services, Charges and Payments. The amendments are proposed to support the exchange of billing and reimbursement data, as well as electronic exchange of medical documentation in the workers' compensation system.

The Texas Register published text shows words proposed to be added to or deleted from the current text, and should be read to determine all proposed changes.

Currently, the majority of medical bills in the Texas workers' compensation system are submitted on paper forms to insurance carriers, third party administrators, or to medical bill review vendors. Minimal electronic billing occurs in the system. Insurance carriers report professional and hospital bill payment data to the commission in electronic file formats developed specifically for Texas workers' compensation. The commission does not currently collect pharmacy and dental data.

House Bill 2511 (HB 2511), passed in 1999 by the 76th Texas Legislature added Texas Labor Code §401.024 which allows the commission to adopt rules to permit or require electronic transmission in place of established forms, manners, or procedures that require paper processing. The proposed amendments are part of the commission's Electronic Billing and Reimbursement (eBill) project initiated to identify and implement an electronic billing solution for the Texas workers' compensation system. The eBill project is a component of the commission's Business Process Improvement (BPI) initiative; a coordinated set of projects that use technology to streamline agency processes to meet the goals set out in HB 2511.

Proposed amendments to Chapter 134, concerning Benefits--Guidelines for Medical Services, Charges, and Payments, specify that the use of standard medical billing forms is applicable to medical bills submitted in paper form and does not apply to medical bills submitted electronically. Additionally, the proposed amendments clarify that a carrier's reporting of medical billing data to the commission includes payment data.

Proposed amendments to subsections (a) and (e) of §134.800, concerning Required Billing Forms and Instructions, are amended to allow health care providers and insurance carriers to exchange medical bill data, payment data, and documentation electronically by mutual agreement. The proposed amendment requires that the agreement must include stipulations defining a complete electronic medical bill and the method and manner related documentation is submitted to the insurance carrier. The proposed amendments exclude transmission by facsimile and electronic mail in the mutual agreement provision. Proposed amendments replace the term "Commission" in place of the "Medical Review Division" in subsection (f) and eliminate subsection (g).

Amendments to §134.802, concerning Insurance Carrier's Submission of Medical Bills to the Commission, adds the phrase "and payment" to the insurance carrier requirement to submit medical billing data to the commission. The amendment does not change current reporting processes or requirements. It makes the language consistent with the intent to collect medical bill and payment information, which includes payment, denial, and refund data. The amendment also changes the title from "Insurance Carrier's Submission of Medical Bills to the Commission" to "Insurance Carrier Medical Electronic Data Interchange to the Commission" and is consistent with the commission's BPI Medical EDI project.

Stacey Jefferson, Director of the Business and Information Technology Services Division, has determined that for the first five-year period the proposed rule is in effect there may be fiscal implications for state or local governments as a result of enforcing or administering the rule. There is no adverse fiscal impact for state or local governments that do not change medical billing and reimbursement processes, as the amendments do not mandate electronic exchange of billing and reimbursement data. The potential fiscal impact is related to administrative costs affected by a reduction in paper processing for state or local governments that choose to implement electronic billing and reimbursement. Start up costs anticipated to implement an electronic interface may be offset by a reduction in administrative costs for paper processing, however, the overall impact cannot be quantified at this time.

Local government and state government as a covered regulated entity will be impacted in the same manner as described below in this preamble for persons and entities required to comply with the rules as amended.

Ms. Jefferson has also determined that for each year of the first five years the amended rules are in effect, the public benefit will be greater flexibility for system participants to exchange medical billing, reimbursement, and documentation data electronically.

There is no anticipated economic impact to those persons or entities that choose to continue their existing medical bill submission and processing practices, as these amendments do not mandate electronic exchange of information.

Health care providers and insurance carriers, including certified self-insured employers, who are not already exchanging data electronically but choose to initiate electronic processes may experience start up costs related to implementation of an electronic interface. It is expected that start up costs will likely be offset by a decrease in overall administrative costs for generating and processing paper medical bills and documentation.

Employers who purchase workers' compensation insurance should experience no direct economic impact from the requirement to comply with these proposed amendments because there is no additional administrative requirement for the employer.

There will be no economic costs to employees, as these amendments do not impose any requirements on injured employees.

There may be costs of compliance for small businesses that do not currently exchange data electronically but choose to implement electronic interfaces. Start up costs related to implementation of electronic interfaces may be offset by a decrease in overall administrative costs related to paper processing of medical bills and data.

There is no anticipated adverse economic impact on small businesses or micro-businesses as a result of these amendments, as electronic exchange of information is not mandated. There will be no difference in anticipated costs of compliance for small and micro-businesses as compared to large businesses.

Comments on the proposed rule amendments must be received by 5:00 p.m., March 7, 2005. You may comment via the Internet by accessing the commission's website at www.twcc.state.tx.us and clicking on "Rules" then clicking on "Proposed Rules for Comment." This medium for commenting will help you organize your comments by rule chapter. You may also comment by emailing your comments to RuleComments@twcc.state.tx.us or by mailing or delivering your comments to Linda Velasquez at the Office of the General Counsel, Mailstop #4-D, Texas Workers' Compensation Commission, 7551 Metro Center Drive, Suite 100, Austin, TX 78744.

Commenters are requested to clearly identify by number the specific rule and paragraph (e.g., 134.800 (a), 134.802(a), etc.) commented upon. The commission may not be able to respond to comments that cannot be linked to a particular proposed rule. Along with your comment, it is suggested that you include the reasoning for the comment in order for commission staff to fully evaluate your recommendations.

Based upon various considerations, including comments received and the staff's or commissioners' review of those comments, or based upon the commissioners' action at the public meeting, the rule as adopted may be revised from the rule as proposed in whole or in part.

A public hearing on this proposal will be held on February 17, 2005 at the Austin central office of the commission (7551 Metro Center Drive, Suite 100, Austin, Texas). Those persons interested in attending the public hearing should contact the Commission's Office of Executive Communications at (512) 804-4430 to confirm the date, time, and location of the public hearing for this proposal. The public hearing schedule will also be available on the commission's website at www.twcc.state.tx.us .

The proposed amendments are proposed under the following statutes: Texas Labor Code §402.061, which gives the Commission the authority to adopt rules as necessary to implement and enforce the Act; 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 §408.025, which requires the Commission to specify by rule the reports a health care provider is required to file; Texas Labor Code §408.027, which provides for insurance carrier payment of health care providers; Texas Labor Code §413.007, which directs the Medical Review Division to maintain a statewide database of medical billing information; Texas Labor Code §413.008 which authorizes the commission to collect certain medical bill and payment information from the insurance carrier; and HB 2511, 76th Texas Legislature which sets goals for the reduction of paper communication requirements.

No other code, statute, or article is affected by this rule action.

§134.800.Required Billing Forms and Information.

(a) Except as provided by §134.801 of this title (relating to Submitting Medical Bills for Payment), health care providers shall submit medical bills for payment on standard forms used by the Centers for Medicare and Medicaid Services (CMS) , [ or ] applicable forms prescribed in subsections (b) , [ and ] (c), and (d) , completed in accordance with Commission instructions , or electronic transmissions submitted in accordance with subsection (e) of this section . All information on medical bills shall be legible when submitted.

(b) Except as provided in subsections (c), [ and ] (d) , and (e) of this section, all health care providers, as defined in §401.011 of the Texas Labor Code, shall submit medical bills using national standard health insurance claim forms, prepared according to Commission instructions.

(c) Pharmacists shall submit bills using the Commission form TWCC-66, Statement for Pharmacy Services, prepared according to Commission instructions.

(d) Dentists shall submit bills using a billing form currently approved by the American Dental Association prepared according to Commission instructions.

(e) Health care providers and the insurance carrier may mutually agree to exchange medical bill and reimbursement data electronically. The mutual agreement shall stipulate the elements that constitute a complete electronic medical bill and the method and manner related documentation is submitted to the insurance carrier. For the purposes of this subsection, electronic billing and reimbursement excludes transmission by facsimile or electronic mail. [ may submit medical bills by facsimile or electronic transmission, when mutually agreed upon between the health care provider and the insurance carrier, unless the bill and/or supporting documentation cannot be sent by those media, in which case the health care provider shall send the documentation by mail or personal delivery. ]

(f) The Commission [ Medical Review Division ] may order the health care provider to reimburse a carrier when the carrier pays the health care provider in excess of the amount allowed by the appropriate Commission fee guideline.

[ (g) This rule shall apply to all dates of service on or after September 1, 2004.]

§134.802.Insurance Carrier [ Carrier's Submission of ] Medical Electronic Data Interchange [ Bills ] to the Commission.

(a) The insurance carrier shall submit medical bill and payment [ billing ] data to the Commission within 30 days after the insurance carrier makes payment, denies payment, or receives a refund of overpayment on a medical bill.

(b) Insurance carriers shall submit medical bill and payment [ billing ] data electronically in the form and format prescribed by the Commission.

(c) The Commission shall prescribe the form, format, and content of the required medical bill and payment [ billing ] data submission.

(d) This rule shall apply to all dates of service on or after July 15, 2000, for facility and professional medical services except pharmacy and dental services.

(e) This rule shall apply to all dates of service on or after January 1, 2005, for pharmacy and dental services in addition to the already required facility and professional medical services.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 24, 2005.

TRD-200500293

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Earliest possible date of adoption: March 6, 2005

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


Chapter 166. WORKERS' HEALTH AND SAFETY--ACCIDENT PREVENTION SERVICES

28 TAC §166.4, §166.6

The Texas Workers' Compensation Commission ("commission") proposes amendments to rules 28 TAC §166.4, concerning Required Accident Prevention Services and §166.6, concerning Exchange of Information for the Inspection. The amendments are proposed pursuant to §413.021, of the Texas Labor Code, 77th Legislature, 2001. The proposed amendments add another category of information (i.e. the availability of return to work coordination services) to the list of what must be included in an existing required notice to policyholders. The information is required to be provided by the insurance carrier to increase awareness of the carrier's available service regarding injured employee return-to-work coordination. The amendments also include adding documentation related to employee return-to-work coordination services to an existing list of information that investigators can require be made available.

The Texas Register published text shows words proposed to be added to or deleted from the current text, and should be read to determine all proposed changes.

House Bill 2600, passed by the 77th Texas Legislature, 2001, added Section 413.021 to the Texas Labor Code, which requires insurance carriers to (with the agreement of a participating employer) provide employers with return-to-work coordination services as necessary to facilitate an employee's return to employment. Insurance carriers must notify employers of the availability of return-to-work coordination services. In offering the services, insurance carriers must target employers without return-to-work programs and focus return-to-work efforts on workers who begin to receive temporary income benefits. These services may be offered by insurance carriers in conjunction with the accident prevention services provided under Section 411.061. Texas Labor Code Section 413.021(b) provides examples of the types of return-to-work services that can be provided.

The proposed change to §166.4 would add notification of return-to-work coordination services to the section title, to the notification topics included in the written solicitation of comments provided to each policyholder (subsection (c)(2)(E)), and to the notice required on the declarations page or on the front of policies that are delivered or issued for delivery in Texas (subsection (c)(8)). In order to allow division inspectors to collect return-to-work documentation, proposed Section 166.6 would add return-to-work coordination services information to the list of types of information that may be requested during agency inspections. The gathering of return-to-work information during these inspections is not intended to prescribe the organization of return-to-work functions within the structure of the entity being inspected. Rather, the agency would be taking advantage of this on-site inspection as an opportunity to gather documentation and verify that return-to-work coordination services are being offered. This constitutes the most efficient use of limited agency resources.

Mr. William DeCabooter, Director of the Workers' Health and Safety Division, has determined that for the first five-year period the proposed rule is in effect there will be no fiscal implications for state or local governments as a result of enforcing or administering the rule because the additional information will be provided to the agency within an existing process and is therefore not expected to require additional staff. Local government and state government as covered regulated entities will be impacted in the same manner as described later in this preamble for persons required to comply with the rule as proposed.

Mr. DeCabooter has also determined that for each year of the first five years the rule as proposed is in effect the public benefits anticipated as a result of enforcing the rule will be increased interaction between the insurance carrier and employer to facilitate the injured employee's return to employment. This should, in turn, result in better return-to-work services provided to injured employees. Improving return-to-work statistics in Texas would be a benefit to all system participants. Injured employees will benefit from staying at work and appropriate early return to work. Studies show that injured employees who return to employment as soon as possible, experience better physical, mental, and emotional health and have a better quality of life. Employers should benefit from reduced premiums based on earlier return to work of injured employees, which will impact income benefits.

There will be no anticipated significant economic costs to persons who are required to comply with the rule as proposed (minimal incidental costs may be associated with any necessary changes to carrier forms and procedures).

There will be no adverse economic impact on small businesses or micro-businesses. There will be no difference in the cost of compliance for small businesses and micro-businesses as compared to large businesses.

Comments on the proposal must be received by 5:00 p.m., March 7, 2005. You may comment via the Internet by accessing the commission's website at www.twcc.state.tx.us and then clicking on "Rules" at the top of the page and then clicking on "Proposed Rules for Comment." This medium for commenting will help you organize your comments by rule chapter. You may also comment by emailing your comments to RuleComments@twcc.state.tx.us or by mailing or delivering your comments to Linda Velasquez, Legal Services, Mailstop #4-D, Texas Workers' Compensation Commission, 7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1609.

Commenters are requested to clearly identify by number the specific rule and paragraph commented upon. The commission may not be able to respond to comments that cannot be linked to a particular proposed rule. Along with your comment, it is suggested that you include the reasoning for the comment in order for commission staff to fully evaluate your recommendations.

Based upon various considerations, including comments received and the staff's or commissioners' review of those comments, or based upon the commissioners' action at the public meeting, the rule as adopted may be revised from the rule as proposed in whole or in part. Persons in support of the rule as proposed, in whole or in part, may wish to comment to that effect.

A public hearing on this proposal will be held on February 17, 2005 at the Austin central office of the commission (7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1609). Those persons interested in attending the public hearing should contact the commission's Office of Executive Communication at (512) 804-4430 to confirm the date, time, and location of the public hearing for this proposal. The public hearing schedule will also be available on the commission's website at www.twcc.state.tx.us .

The amendment is proposed under Texas Labor Code §413.021 (as amended), Texas Labor Code, §402.061, which authorizes the commission to adopt rules necessary to administer the Act, the Texas Labor Code, §411.061, which requires an insurance company to provide accident prevention services, and Texas Labor Code §411.063-.068, which requires an insurance company to provide qualified accident prevention services, set certain specifications for the program, require an insurance company to annually submit information to the commission, require biennial inspections by the division, and provide for an administrative penalty for violation of the requirements.

No other code, statute, or article is affected by this rule action.

§166.4.Required Accident Prevention Services and Notification of Return-to-Work Coordination Services .

(a) An insurance company writing workers' compensation insurance in Texas shall maintain or provide accident prevention facilities and services and shall have them inspected by the division. An insurance company writing only excess or reinsurance is not required to maintain or provide such facilities or services.

(b) An insurance company shall provide accident prevention services to policyholders at no additional charge.

(c) An accident prevention service program as required by the Texas Labor Code, §411.061, shall provide, at a minimum:

(1) an evaluation of the policyholder's need for accident prevention services every 12 months based on the following criteria:

(A) hazard, including classification by hazard group, probability of serious or catastrophic type accidents, probability of frequent accidents, and probability of occupational illness or disease;

(B) experience, including loss ratio, experience modifiers, frequency rate, and severity rate, and

(C) size, including total number of employees, number of locations per policyholder business and number of employees per location.

(2) service in accordance with the following requirements:

(A) provide services requested by policyholders within 15 days of the date services were first requested, if appropriate services can be provided from the insurance company offices and within 30 days of the date of first request, if the services require an on-site visit. Services may be provided at a later time if circumstances require and the time is agreed upon by the policyholder.

(B) an on-site visit, or provision of other appropriate services, on a periodic basis and at least every 12 months to each policyholder with:

(i) a premium of less than $25,000 and a loss ratio greater than 100%; or

(ii) a premium of $25,000 or more;

(C) a mandatory on-site visit on a periodic basis and at least every 12 months to each policyholder with:

(i) a premium of $25,000 or more and a loss ratio greater than 100%; or

(ii) a premium between $5,000 and $24,999, inclusive, and a loss ratio greater than 250%;

(D) a visit to the insured within three working days of notification and/or knowledge of a fatality. If the fatality occurred outside of Texas or was the result of an accident on a common carrier, no visit is required; and

(E) written solicitation of comments from each policyholder, at least every 12 months, to determine the need for safety information or assistance. Such letter shall specifically explain that accident prevention services, including surveys, recommendations, training programs, consultations, analysis of accident causes, industrial hygiene and industrial health services are available at no additional charge and shall be provided upon request directly to the policyholder. This requirement is in addition to the requirements in paragraph (8) of this subsection . The letter shall also include the insurance carrier's notification to the employer of the availability of return-to-work coordination services ;

(3) a sufficient number of qualified personnel performing the duties of field safety representative to provide service at the frequency required in paragraph (2) of this subsection;

(4) written procedures for:

(A) determining the appropriate accident prevention services to be provided to a policyholder;

(B) the time frame and manner in which the services identified under paragraph (2) of this subsection will be delivered to a policyholder;

(C) providing safety training to policyholders and providing promotional and course materials that are available for each safety training program; and

(D) providing written reports to the insurance company and the policyholders which identify hazardous conditions and work practices on the policyholder's premises;

(5) written records, reports, and evidence of all accident prevention services provided to each policyholder;

(6) written notification at least every 12 months to each policyholder of actual claims experience;

(7) written documentation of loss analysis at least every 12 months to each policyholder with:

(A) a premium of $25,000 or more; or

(B) a premium between $5,000 and $24,999, inclusive, and a loss ratio of greater than 250%;

(8) evidence that each workers' compensation insurance policy delivered or issued for delivery in Texas contains the following notice on the declarations page or on the front of the policy in at least 10-point bold type: "(Name of company) is required by law to provide its policyholders with certain accident prevention services as required by the Texas Labor Code, §411.066, at no additional charge and return-to-work coordination services as required by Texas Labor Code §413.021 . If you would like more information, call (insurance company's loss control division or provider's telephone number). If you have any questions about this requirement, call the Division of Workers' Health and Safety, Texas Workers' Compensation Commission at 1-800- 687-7080 [ 452-9595 ]."; and

(9) annual reports as required by §166.3 of this title (relating to Annual Report to the Commission).

§166.6.Exchange of Information for the Inspection.

(a) Pre-Inspection Exchange of Information.

(1) At least 45 days prior to the date set for inspection, the insurance company shall provide the division with:

(A) a list of policyholder accounts by policyholder name, policy number, effective date or expiration date of policy, written premium before any adjustments, including deductibles or discounts, and Texas locations. The list shall be taken from the insurance company's most current records, separated by affiliated companies, arranged in descending order by premium, and include all policies which had been in effect or have been written since the policyholder list was prepared for the last inspection of the insurance company's accident prevention services by the division; and

(B) a list of the name, location, status (whether employee or contractor), and proof of qualifications as set forth in the Texas Labor Code §411.062 and §166.8 of this title (relating to Qualification of Field Safety Representatives) of each person acting as a field safety representative for the insurance company.

(2) Within ten days of receipt of the list, the division shall select the specific accounts to be evaluated and notify the insurance company of those accounts. The list of policyholder accounts will be kept confidential to the extent permitted by law. The division shall return the list to the insurance company at the time of the inspection.

(3) At least 35 days prior to the date set for inspection, the insurance company shall provide the division with the completed Accident Prevention Services Questionnaire provided by the commission. The questionnaire shall have been completed and signed by an individual authorized by the insurance company to be responsible and whose signature has been notarized on the questionnaire form.

(4) For each account selected by the division, the insurance company shall prepare an accident prevention services worksheet on the form prescribed by the commission.

(5) At least five days prior to the date of the inspection, the insurance company shall file the completed worksheets with the division.

(b) Information to be made available at the inspection.

(1) The insurance company shall make available the following information, as of the date of the last inspection or start of writing workers' compensation coverage, whichever is later, at the time and site of the inspection:

(A) the loss control files corresponding to the requested worksheets;

(B) evidence that the policyholder has been provided the notice required by this chapter and any other material used to notify policyholders of the accident prevention services;

(C) a copy of all accident prevention services procedures;

(D) a copy of loss runs for each selected account that will include:

(i) number of injuries;

(ii) accident or illness types;

(iii) body parts involved;

(iv) injury causes; and

(v) fatalities;

(E) if continuing education or training are required by the commission, a record of any training received by the field safety representatives since the previous inspection;

(F) a sample of policyholder training materials, audiovisual aids, and training programs; and

(G) other information requested by the inspector which is necessary to complete the inspection.

(2) The insurance company shall also provide the information required by subsection (a) of this section which is not already in the possession of the division.

(3) Upon request from the division inspector, the insurance company shall provide copies of documents requested, accompanied by a notarized Business Record Affidavit. Information which may be requested shall be limited to records of surveys, consultations, recommendations, training provided, training materials available, loss runs and loss analyses, industrial health and hygiene services, accident prevention procedures and field safety representative qualifications. In addition, upon request from the division inspector, the insurance company shall provide return-to-work coordination services information. The Business Record Affidavit form shall be provided by the inspector and shall be completed and signed by an individual authorized by the insurance company.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 24, 2005.

TRD-200500291

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Earliest possible date of adoption: March 6, 2005

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