TITLE 28.INSURANCE

Part 2. TEXAS WORKERS' COMPENSATION COMMISSION

Chapter 103. AGENCY ADMINISTRATION

Subchapter B. AGENCY CONTRACTS

28 TAC §103.101

The Texas Workers' Compensation Commission (the commission) adopts new §103.101, concerning vendor protest procedures, without changes to the proposed text published in the April 27, 2001 issue of the Texas Register (26 TexReg 3122) which will not be republished. The new rule provides the procedure an aggrieved party must follow to resolve a dispute in connection with the solicitation, evaluation or award of any contract with the commission. The new rule provides vendors a procedure to resolve protests relating to the solicitation, evaluation, or award of a contract by the commission. Senate Bill 1752 of the 75th Legislature, 1997, added Government Code §2155.076 to the State Purchasing Act to require each state agency to develop and adopt protest procedure rules for resolving vendor protests relating to purchasing issues. Section 2155.076 requires an agency's rules to be consistent with the General Services Commission (GSC) rules, which are located in 1 TAC Chapter 111.

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.

No comments were received regarding the proposed new rule.

This new rule provides a procedure for an actual or proposed bidder, offeror or contractor to follow to protest the solicitation, evaluation, or award of a contract. The contents of the protest, time period for filing a protest, and notice required is set out in the proposed new rule. The commission is given the authority to settle the protest, or if it is not resolved, to issue a written determination on the protest. The proposed new rule provides for the appeal of the commission's decision to the executive director whose decision is the final administrative action of the commission. The proposed rule requires that in the event of a protest, documents collected in association with the solicitation, evaluation, and/or award of a contract be maintained by the commission for four years.

The new rule is adopted under the Texas Labor Code §402.041, which sets out the role of the executive director, the 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 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 Government Code §2155.076, which requires each state agency to develop and adopt protest procedure rules for resolving vendor protests relating to purchasing issues.

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 June 27, 2001.

TRD-200103672

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: July 17, 2001

Proposal publication date: April 27, 2001

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


Subchapter C. RESOLUTION OF CONTRACT CLAIMS

28 TAC §§103.300 - 103.322

The Texas Workers' Compensation Commission (the commission) adopts new §§103.300-103.322, concerning negotiation and mediation of certain breach of contract claims asserted by contractors against the commission, without changes to the proposed text published in the April 27, 2001 issue of the Texas Register (26 TexReg 3124) which will not be republished. These new sections are necessary to establish procedures for negotiation and mediation in accordance with Texas Government Code, Chapter 2260, which requires each state agency to adopt rules to govern the negotiation and mediation of certain claims for breach of contract.

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.

No comments were received regarding the proposed new rule.

Sections 103.300-103.322 are based on model rules adopted by the Office of the Attorney General. Section 103.300 states that the purpose of the rules is the implementation of Government Code, Chapter 2260. Section 103.301 sets out the applicability of the rules. Section 103.302 contains the definitions of terms used in the proposed rules. Section 103.303 establishes that the procedures in the proposed rules are a prerequisite to suit under the Civil Practice & Remedies Code, Chapter 107, and the Government Code, Chapter 2260. Section 103.304 states that the provisions do not waive sovereign immunity to suit or liability.

Section 103.305 sets out the procedures for a contractor to file a claim with the commission. Section 103.306 sets out the procedures for the commission to assert a counterclaim against the contractor.

Section 103.307 requires that the parties, in accordance with the timetable set out in §103.308, negotiate to attempt to resolve claims and counterclaims. Section 103.309 describes the conduct of negotiation. Section 103.310 requires the parties to disclose their settlement approval procedures prior to negotiations. Section 103.311 provides that an agreement to settle a claim must be in writing, signed by representatives of the contractor and the commission who have authority to bind each party. Section 103.312 provides that each party is responsible for its own costs incurred during negotiations.

Section 103.313 describes the process by which a contractor may request a contested case hearing before the State Office of Administrative Hearings on an unresolved claim. Section 103.314 describes the timetable for mediation of a claim. Sections 103.315 through 103.322 describe the mediation process and procedures.

The new rules are adopted under the Texas Government Code, §2260.052 which provides that each unit of state government with rulemaking authority shall develop rules to govern the negotiation and mediation of a claim for a breach of contract; The Texas Labor Code, §402.061 which authorizes the commission to adopt rules necessary to administer the Texas Workers' Compensation Act; the Texas Labor Code, §401.024 which allows the commission to contract with a data collection agent; the Texas Labor Code, §402.042 which sets out the general powers and duties of the executive director of the commission; the Texas Labor Code, §406.004 which requires employer notification to the commission of noncoverage election and which allows the commission to contract with the Texas Employment Commission or the Comptroller for assistance in collecting employer notification; the Texas Labor Code, §413.003 which allows the commission to contract with a private or public entity to perform a duty or function of the Medical Review Division; the Texas Labor Code, §413.051 which allows the commission to contract with entities to develop, maintain, or review medical policies and fee guidelines and compliance therewith.

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 June 27, 2001.

TRD-200103673

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: July 17, 2001

Proposal publication date: April 27, 2001

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


Subchapter D. FACILITIES AND PROPERTY MANAGEMENT

28 TAC §103.400

The Texas Workers' Compensation Commission (the commission) adopts new §103.400, concerning fleet vehicle management program, without changes to the proposed text published in the April 27, 2001, issue of the Texas Register (26 TexReg 3128) which will not be republished. The new rule is adopted in accordance with the requirements of the Texas Government Code §2171.1045, which requires each state agency to adopt rules relating to the assignment and use of the agency's vehicles.

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.

No comments were received regarding the proposed amendment.

House Bill 3125, which was adopted by the 76th Texas Legislature, requires each state agency to adopt rules consistent with the management plan adopted by the Office of Vehicle Fleet Management of the General Services Commission relating to the assignment and use of the agency's vehicles. This rule satisfies that requirement.

This new rule is adopted under the Texas Labor Code, §402.061, which authorizes the commission to adopt rules necessary to administer the Act, and the Texas Government Code, §2171.1045, which requires each state agency to adopt rules consistent with the management plan adopted by the Office of Vehicle Fleet Management of the General Services Commission relating to the assignment and use of the agency's vehicles.

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 June 27, 2001.

TRD-200103674

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: July 17, 2001

Proposal publication date: April 27, 2001

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


Chapter 126. GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS

28 TAC §126.10

The Texas Workers' Compensation Commission (the commission) adopts an amendment to §126.10, concerning the commission-approved list of designated doctors, without changes to the proposed text published in the April 27, 2001 issue of the Texas Register (26 TexReg 3129) which will not be republished. The amendment is adopted to make §126.10 consistent with the language in §130.1 of this title, concerning certification of maximum medical improvement and evaluation of permanent impairment.

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

No comments were received regarding the proposed amendment.

House Bill 2510 passed by the 76th Texas Legislature amended Texas Labor Code §408.124 to allow the commission by rule to adopt the fourth edition of the Guides to the Evaluation of Permanent Impairment , published by the American Medical Association ( AMA Guides ), for determining the existence and degree of an employee's impairment.

Section 130.1 of this title was amended to require the use of the AMA Guides , fourth edition, to evaluate impairment for certifying examinations conducted on or after October 15, 2001, while maintaining the requirement for the use of the AMA Guides , third edition, second printing, 1989, for certifying examination dates before October 15, 2001 and certain others as set out in §130.1(c)(2)(B)(ii). The amendment of §130.1 necessitates the amendment of §126.10 to delete references to a particular edition of the AMA Guides . Instead, the rule refers to §130.1.

Because §130.1 contains the instructions regarding which AMA Guides should be used for determination of an employee's impairment, the amendment to §126.10(a)(2) references §130.01. Eliminating the reference to a particular edition of the AMA Guides in §126.10(a)(2) and referencing the requirement of §130.1, allows the commission to adopt an amendment to §130.1 if necessary, without requiring additional amendments to §126.10.

The amendment is adopted under the Texas Labor Code, §401.011(17), which provides a definition for "doctor"; Texas Labor Code, §401.011(30), which provides a definition for "maximum medical improvement"; Texas Labor Code, §401.024, as amended by the 76th Texas Legislature, 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 and 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, §408.004, which addresses required medical examinations; Texas Labor Code, §408.025, which requires the commission to specify by rule what reports a health care provider is required to file; Texas Labor Code, §408.102, which provides that temporary income benefits continue until the injured employee reaches maximum medical improvement; Texas Labor Code, §408.122, which establishes eligibility for impairment income benefits and provides for the use of designated doctors when a dispute exists regarding the certification of MMI; Texas Labor Code, §408.123, which requires a doctor certifying MMI to file a report and which requires a certification of MMI and assignment of an impairment rating by a doctor other than the treating doctor be sent to the treating doctor who must indicate either agreement or disagreement with the certification of the evaluation; Texas Labor Code, §408.124, which provides the commission the authority to by rule adopt the fourth edition of the " Guides to the Evaluation of Permanent Impairment " published by the American Medical Association to determine the existence and degree of an injured employee's impairment; Texas Labor Code, §408.125, which addresses use of a designated doctor to resolve impairment rating disputes, Texas Labor Code, §413.002 and Chapter 414, which give the commission authority to monitor an evaluate health care providers (including designated doctors), insurance carriers, and workers' compensation claimants to ensure compliance with the rules adopted by the commission and to issue administrative penalties.

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 June 27, 2001.

TRD-200103671

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: July 17, 2001

Proposal publication date: April 27, 2001

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


Chapter 130. IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS

Subchapter A. IMPAIRMENT INCOME BENEFITS

28 TAC §130.6

The Texas Workers' Compensation Commission (the commission) adopts amendments to §130.6, concerning the designated doctor; general provisions, without changes to the proposed text published in the April 27, 2001, issue of the Texas Register (26 TexReg 3131) which will not be republished. This amendment is adopted to make §130.6 consistent with the language in §130.1 of this title, concerning certification of maximum medical improvement and evaluation of permanent impairment.

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.

No comments were received regarding the proposed amendment.

House Bill 2510 passed by the 76th Texas Legislature amended Texas Labor Code §408.124 to allow the commission by rule to adopt the fourth edition of the Guides to the Evaluation of Permanent Impairment , published by the American Medical Association ( AMA Guides ), for determining the existence and degree of an employee's impairment.

Section 130.1 of this title was amended to require the use of the AMA Guides , fourth edition to evaluate impairment for certifying examinations conducted on or after October 15, 2001, while maintaining the requirement for the use of the AMA Guides , third edition, second printing, 1989, for certifying examination dates before October 15, 2001, and certain others as set out in §130.1(c)(2)(B)(ii).

The amendment of §130.1 necessitates the amendment of §130.6 of this title to delete references to a particular edition of the AMA Guides . Because §130.1 contains the instructions regarding which AMA Guides should be used for determination of an employee's impairment, the amendment to §130.6(j) references §130.1. Eliminating the reference to a particular edition of the AMA Guides in §130.6(j) and referencing the requirement of §130.1, allows the commission to adopt amendments to §130.1 if necessary, without requiring additional amendments to §130.6.

The amendment is adopted under Texas Labor Code, §401.011(17), which provides a definition for "doctor"; Texas Labor Code, §401.011(30), which provides a definition for "maximum medical improvement"; Texas Labor Code, §401.024, as amended by the 76th Texas Legislature, 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 and 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, §408.004, which addresses required medical examinations; Texas Labor Code, §408.025, which requires the commission to specify by rule what reports a health care provider is required to file; Texas Labor Code, §408.102, which provides that temporary income benefits continue until the injured employee reaches maximum medical improvement; Texas Labor Code, §408.122, which establishes eligibility for impairment income benefits and provides for the use of designated doctors when a dispute exists regarding the certification of MMI; Texas Labor Code, §408.123, which requires a doctor certifying MMI to file a report and which requires a certification of MMI and assignment of an impairment rating by a doctor other than the treating doctor be sent to the treating doctor who must indicate either agreement or disagreement with the certification of the evaluation; Texas Labor Code, §408.124, which provides the commission the authority to by rule adopt the fourth edition of the Guides to the Evaluation of Permanent Impairment published by the American Medical Association to determine the existence and degree of an injured employee's impairment; Texas Labor Code, §408.125, which addresses use of a designated doctor to resolve impairment rating disputes, Texas Labor Code, §413.002 and Chapter 414, which give the commission authority to monitor and evaluate health care providers (including designated doctors), insurance carriers, and workers' compensation claimants to ensure compliance with the rules adopted by the commission and to issue administrative penalties.

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 June 27, 2001.

TRD-200103675

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Effective date: July 17, 2001

Proposal publication date: April 27, 2001

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