FEE SCHEDULE NEWS:

• New conversion factors have been adopted as of January 1, 2018. The next update is scheduled for January 1, 2019.
• The state of Texas adopts the quarterly Medicare modules update. Please refer to the Medicare modules section for more information.

REGULATORY ACTIVITY:

• Posted notice of amendments to various divisions forms to implement HB 2111.
• The division amends the following forms to replace “hearing officer” with “administrative law judge” and “official de la audencia” with “juez de derecho administrativo:”
  • DWC Form-024, Benefit Dispute Agreement
  • DWC Form-024s, Acuerdo para disputa de beneficios
  • DWC Form-025, Benefit Dispute Settlement
  • DWC Form-025s, Acuerdo por disputa de beneficios
  • DWC Form-049, Request to Schedule a Medical Contested Case Hearing (MCCH)
  • DWC Form-049s, Solicitud para Programar una Audiencia para Disputar Beneficios Médicos (Medical Contested Case Hearing – MCCH, por su nombre y siglas en inglés)
  • DWC Form-150a, Notice of Withdrawal of Representation
  • DWC Form-150as, Aviso de Anulación de Repesentación Legal
  • DWC Form-152, Application for Attorney Fees

    In addition, the fax number has been updated on Forms DWC024, DWC024s, DWC025, and DWC025s to (512) 804-4011.  Finally, the updated revision and barcode date for each of these forms is 11/17.
    The division emphasizes that no substantive or procedural changes have been made to any of these forms.  The division will continue to accept the prior revision form while system participants transition to the updated forms.
    The purpose for these clerical changes is to implement HB 2111 (85th Regular Session) which amended the Texas Workers’ Compensation Act to replace the phrase “hearing officer” with “administrative law judge.”

• Published bulletin B-0041-17 regarding the annual change to the medical fee guideline conversion factors as established in Title 28 TAC Section 134.203.
• The Texas Department of Insurance, Division of Workers' Compensation (DWC) has released the 2017 Health Care Provider Performance Based Oversight (PBO) assessment results. Heath care providers were assessed on their performance in one of three categories:
  • timely filing the DWC Form-069, Report of Medical Evaluation;
  • completeness of the DWC Form-073, Work Status Report; or
  • documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073, Work Status Report.

Of the 152 health care providers reviewed for the timeliness of filing the DWC Form-069, Report of Medical Evaluation: 113 had scores placing them in the high performer tier, 30 were in the average performer tier, and 9 had scores placing them in the poor performer tier.   Of the 87 health care providers reviewed for the completeness of the DWC Form-073, Work Status Report: 50 had scores placing them in the high performer tier, 26 were in the average performer tier, and 11 had scores placing them in the poor performer tier.   Of the 87 health care providers reviewed for documentation supporting why the injured employee was prevented from returning to work, as reported on the DWC Form-073, Work Status Report: 41 had scores placing them in the high performer tier, 29 were in the average performer tier, and 17 had scores placing them in the poor performer tier.   The results and a list of the health care providers included in the 2017 PBO assessment are posted on the Texas Department of Insurance website at www.tdi.texas.gov/wc/pbo/pboresults.html. If a health care provider is not listed, he or she was not assessed in 2017; however, no health care provider in the Texas workers' compensation system is exempt from compliance with the Workers' Compensation Act and DWC rules.  More information on PBO and the 2017 assessment is available on the TDI website at www.tdi.texas.gov/wc/pbo/hcppbo.html. DWC will assess insurance carriers separately in 2018.

REGULATORY ACTIVITY:

• TDI adopts amendments to workers' comp relativities rule: Senate Bill 1336 from the 2019 Texas Legislature eliminated the statutory requirement for the Texas Department of Insurance (TDI) to develop workers' compensation classification relativities. TDI has adopted a rule change to remove rate filing requirements relating to relativities.
• The Division of Workers’ Compensation (DWC) issues a mandatory data call for certain information related to COVID-19 injuries reported to selected insurance carriers on or after December 1, 2019. The Workers’ Compensation Research and Evaluation Group (REG) will compile the results on behalf of DWC. DWC requests this information under Texas Labor Code §§024, 402.00111(b), 402.00128(b) (10) and (12), and Chapter 405. This data call is designed to provide DWC with immediate access to information necessary to determine the impact of COVID-19 injuries on the Texas workers’ compensation system. DWC directs all selected insurance carriers and insurance carrier groups to provide summary data using the COVID-19 data call reporting forms and instructions. Each selected insurance carrier or group is required to provide one data submission per insurance carrier or group. Insurance carriers and groups must submit the requested data to DWC through the insurance carrier Austin representative’s Secure File Transfer Protocol box no later than 5 p.m., Central time on August 17, 2020. This submission should include all COVID-19 exposures and injuries reported and payments made on these injuries through June 30, 2020. See the schedule attached to this bulletin for subsequent submission deadlines. Subsequent data call submissions are cumulative. Insurance carriers should maintain injury level data for the injuries reported in this data call and may be asked to submit that data to DWC in the future. For questions about this bulletin, please contact the Workers’ Compensation Research and Evaluation Group at WCResearch@tdi.texas.gov.  To view this bulletin, go to https://www.tdi.texas.gov/bulletins/index.html.
• Published bulletin B-0030-20 regarding Coronavirus (COVID-19) - resuming certain designated doctor examinations and required medical examinations.  To view the bulletin, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting public comments on a proposed rule amending 28 Texas Administrative Code §132.7 to conform to Texas Labor Code §408.183. The Legislature amended Labor Code §408.183 under House Bill (HB) 2503, which went into effect September 1, 2019.  The proposed changes will align DWC’s rules regarding the duration of death benefits with the statutory changes made by HB 2503. HB 2503 expanded eligibility of spouses who may receive death benefits for life, regardless of remarriage, to spouses of peace officers as described in Texas Code of Criminal Procedures Article 2.12 and intrastate fire mutual aid system team members or regional incident management team members. HB 2503 only applies to an eligible spouse who remarries on or after September 1, 2019.  To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance (TDI) is extending a requirement that insurers cover telemedicine services, including mental health visits, at the same rate as in-person visits. An emergency rule in place since March helps doctors across Texas treat their patients and limit the spread of COVID-19. “This extension will help protect patients and our state’s health-care professionals while maintaining access to care,” said Insurance Commissioner Kent Sullivan. Under the emergency rule, state-regulated health insurers and health maintenance organizations must:
  • Pay in-network health professionals at least the same rate for telemedicine services as for in-person services, including covered mental health services.
  • Cover telemedicine services using any platform permitted by state law.
  • Not require more documentation for telemedicine services than they require for in-person services.

In March, Governor Greg Abbott suspended a law limiting coverage for medical services and consultations provided by phone. The suspension remains in place and means insurers must pay for covered visits or consultations provided over the phone. The original emergency rule took effect March 17 and was set to expire July 14. With the extension, the rule will remain in effect through September 12.  State-regulated plans, including those purchased through Healthcare.gov, cover about 15% of the Texas market. The insurance cards for state-regulated plans have either “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them.  To view this notice, go to https://www.tdi.texas.gov/news/2020/tdi06242020.html.

• TDI has approved the National Council on Compensation Insurance (NCCI) filing Item U-1401- Nature and Cause of Injury Codes for COVID-19 (Coronavirus) Claims. The changes in Item U-1401 apply to new and renewal policies effective for claims attributable to COVID-19 with accident dates on and after December 1, 2019.

REGULATORY ACTIVITY:

• Issued notice of review of all sections 28 Texas Administrative Code Chapters 126-128. DWC is accepting public comment on whether the rules in 28 TAC Chapters 126-128 still have reason to exist or should be repealed, readopted, or readopted with amendments as required under Texas Government Code §2001.039.  To comment on this rule review project, submit your written comments by 5 p.m., Central time, on June 8, 2020. .  To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance has issued a bulletin reminding insurers, agents, agencies, and adjusters that a sponsor for someone with a temporary license is: responsible for the acts of the temporary or emergency licensee; expected to review the applicant’s background to ensure suitability for licensure; and expected to monitor behavior and provide required training.  To view this bulletin, go to https://www.tdi.texas.gov/bulletins/2020/B-0026-20.html.
• Issued a memorandum regarding per-authorization extensions.  On March 22, 2020, Governor Greg Abbott issued Executive Order No. GA-09, directing all licensed health  care professionals and facilities to postpone all surgeries and procedures not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, the patient.  On April 17, 2020, Governor Abbott issued Executive Order No. GA-15, allowing elective surgeries and procedures under certain circumstances.   To help injured employees receive medical care they need to treat their work-related injuries without an unnecessary administrative delay, the Division of Workers’ Compensation encourages Texas workers’ compensation insurance carriers and utilization review agents to extend pre-authorizations issued before March 22, 2020, without a request from a health care provider, and provide injured employees and health care providers with written notice of updated authorizations. These extensions do not apply to one-time pre-authorizations for medical care that has already been completed, new preauthorization requests, or pharmacy pre-authorizations.  Workers’ compensation certified networks and political subdivision health plans under Labor Code Section  504.053(b)(2) are encouraged to extend injured employee referrals for specialists, therapy, and other medically necessary services to prevent disruptions in the continuity of their medical care.  Please direct questions to compconnection@tdi.texas.gov.
• TDI issued an order adopting National Council on Compensation Insurance (NCCI) Item 01-TX-2019—Revisions to Basic Manual for Workers’ Compensation and Employers Liability Insurance and Forms Manual of Workers’ Compensation and Employers Liability Insurance in Texas. The filing eliminates references to relativities, revises the rate basis for payroll for Texas special Code 0923—Domestic Workers—Residences—Payroll Basis, and makes minor updates to some references and outdated sections of the manual. The changes apply to new and renewal workers' compensation policies effective on and after July 1, 2020.
• The Texas Department of Insurance, Division of Workers' Compensation (DWC) is readopting all sections in 28 Texas Administrative Code Chapters 120, 122, and 124.   This re-adoption complies with Texas Government Code §2001.039, which requires a state agency to review each rule every four years and readopt, readopt with amendments, or repeal the rule. A notice of rule review was published in the January 31, 2020, issue of the Texas Register.   DWC has determined that the reasons for adopting the chapters continue to exist. The notice of read option will be published in the June 5, 2020, issue of the Texas Register.
• The National Council on Compensation Insurance (NCCI) filed Item B-1441 – Revisions to NCCI Manual Rules Related to the COVID-19 (Coronavirus) Pandemic. The filing revises and establishes rules for the treatment and reporting of employer payments for employees furloughed due to the pandemic. NCCI proposes that Item B-1441 apply to policies effective on and after March 1, 2020.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is required to monitor workers’ compensation system participants’ compliance with the Texas Labor Code and DWC rules. Compliance objectives are achieved through Performance Based Oversight (PBO), data monitoring, complaint handling, audits, and enforcement actions. As part of the overall compliance plan, Texas Labor Code §402.075 requires DWC to assess the performance of system participants in meeting the key regulatory goals established by the commissioner of workers’ compensation. Based on the performance assessment, health care providers are placed into regulatory tiers: poor performers, average performers, and high performers. DWC focuses its regulatory oversight on the poor performers. The 2021 PBO assessment will evaluate health care providers on the following categories: • DWC Form-073, Work Status Report; and • DWC Form-069, Report of Medical Evaluation. To view this announcement, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.

FEE SCHEDULE NEWS:

• A new dental fee schedule has been adopted retroactive to January 1, 2020. No update to Home Health rates has been released.  The next updates are expected in July 2020.

REGULATORY ACTIVITY:

• Issued notice regarding COVID-19 Centers for Medicare and Medicaid Services guidance on telemedicine and telehealth. To view a copy of the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• Issued bulletin B-0019-20: On March 13, 2020, Governor Greg Abbott declared COVID-19 a statewide public health disaster. The Division of Workers’ Compensation (DWC) is working diligently to help system participants and protect the health and safety of the public in our response to COVID-19. Governor Abbott suspended Health and Safety Code Section 81.050(j) and 28 Texas Administrative Code Section 122.3(c) regarding 10-day testing requirements. As symptoms of COVID-19 exposure may take over 10 days to manifest, strict compliance with these laws could prevent, hinder, or delay state efforts to provide workers’ compensation coverage for emergency responders. This bulletin is in effect for the duration of the governor’s COVID-19 declaration, or until further notice from DWC. Please continue to follow the CDC’s recommendations, and refer to the DWC COVID-19 resource page for updates, FAQs, and contact information. Cassie Brown Commissioner of Workers’ Compensation
  Texas Department of Insurance, Division of Workers’ Compensation.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is adopting new 28 Texas Administrative Code §167.1 on an emergency basis. The rule relates to telemedicine and telehealth and will go into effect immediately for physical medicine and rehabilitation services provided on or after April 13, 2020.  The emergency adoption is necessary to ensure enhanced access to telemedicine and telehealth services in response to the COVID-19 disaster declaration.  This emergency rule builds on the existing telemedicine and telehealth rules by creating an exception to current CMS distant site practitioner requirements. This rule allows health care providers licensed to perform physical medicine and rehabilitation services, including physical therapists,  occupational therapists, and speech pathologists to bill and be reimbursed for services currently allowed under CMS telemedicine and telehealth billing codes. To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the rule, go to https://www.tdi.texas.gov/wc/rules/2020rules.html.
• The Texas Department of Insurance (TDI) has issued bulletin 0020-20 to encourage insurers to work with commercial policyholders that have premiums based on payroll, sales, or a similar auditable exposure. TDI requests that insurers conduct midterm audits and accept self-reports of changes to adjust premiums as appropriate. To view the bulletin, go to  https://www.tdi.texas.gov/bulletins/2020/B-0020-20.html.
• On March 13, 2020, Governor Greg Abbott declared COVID-19 a statewide public health disaster. The Division of Workers’ Compensation (DWC) is working diligently to help system participants and protect the health and safety of the public in our response to COVID-19. On March 27, 2020, Governor Abbott approved DWC’s request to suspend testing, training, and application requirements for DD and MMI/IR re-certification under 28 Texas Administrative Code (TAC) Sections 127.110(b)(1) and (3), 127.110(d), and 180.23. As a result, DWC will issue interim re-certifications to certified Texas-licensed DDs with no relevant practice restrictions, as described in 28 TAC Section 127.110(e)(3) and MMI/IR-only doctors certified to perform examinations under 28 TAC Section 180.23. DWC will issue the interim re-certifications to doctors whose prior certifications lapse March 27, 2020, through August 31, 2020. All interim re-certifications will expire December 31, 2020. As this issue evolves, DWC will continue to evaluate the need to issue interim re-certifications for doctors with DD and MMI/IR certifications lapsing after August 31, 2020. This bulletin is in effect for the duration of the governor’s COVID-19 declaration, or until further notice from DWC. Please continue to follow the CDC’s recommendations, and refer to the DWC COVID-19 resource page for updates, FAQs, and contact information. To view the complete bulletin, go to https://www.tdi.texas.gov/bulletins/2020/B-0023-20.html.
• The National Council on Compensation Insurance (NCCI) filed Item U-1401- Nature and Cause of Injury Codes for COVID-19 (Coronavirus) Claims. The filing proposes that the changes in Item U-1401 apply to new and renewal policies effective for claims attributable to COVID-19 with accident dates on and after December 1, 2019. To view this filing, go to https://www.tdi.texas.gov/rules/2020/nccimanual.html.

REGULATORY ACTIVITY:

• The Research and Evaluation Group has released a report on return to work in the Texas workers' compensation system. This report analyzes return-to-work outcomes, including the percentage of injured employees who initially return to work after their injury, the percentage who remain at work, and the average days away from work. To view this announcement, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  
• The Texas Department of Insurance has posted notice of a filing by the National Council on Compensation Insurance (NCCI) about proposed changes in NCCI's Basic Manual Classifications and Appendix E, including Construction Salespersons and Estimators. The filing proposes that the changes in Item B-1439 apply to new and renewal workers' compensation policies effectively on and after July 1, 2021.   Texas has adopted amendments to rule Chapter 129 Income Benefits - Temporary Income Benefits. The proposed amendments were published on October 11, 2019, in the Texas Register.  The amendments are adopted without changes to the proposed amendments.  To view the adopted rule, go to https://www.tdi.texas.gov/wc/rules/2020rules.html.  
• The Texas Department of Insurance, Division of Workers' Compensation (DWC) will review all sections in 28 Texas Administrative Code (TAC) Chapters 126-128.  DWC is accepting public comments on whether the rules in 28 TAC Chapters 126-128 still have reason to exist or should be repealed, readopted, or readopted with amendments as required under Texas Government Code §2001.039.   To comment on this rule review project, submit your written comments by 5 p.m., Central time, on April 27, 2020.   Email your written comments or hearing request to rulecomments@tdi.texas.gov or mail to  Cynthia Guillen Legal Services, MS-4D Texas Department of Insurance, Division of Workers' Compensation 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645. To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  
• The Division of Workers’ Compensation (DWC) is committed to ensuring a fully operational system with excellent customer service while taking necessary precautions to promote a safe environment for all system participants.  DWC continues to monitor the latest developments on COVID-19 and created a webpage with information for stakeholders in the Texas workers’ compensation system. Please refer to the DWC COVID-19 resource page for periodic updates.   DWC is taking the following steps regarding operations:
• Benefit Review Conferences - As of Monday, March 16, 2020, DWC will hold Benefit Review Conferences by telephone. DWC staff will contact parties to provide details.
• Contested Case Hearings - Contested Case Hearings (CCH) scheduled for March 16-27, 2020, will be rescheduled.  Beginning March 30, 2020, CCHs will resume and be conducted by telephone.  Parties should send exhibits they will offer into evidence to DWC and other parties at least three business days prior to the scheduled CCH. DWC encourages parties to use encrypted email or fax when exchanging evidence.
• Designated Doctors Scheduling - Designated doctors should inform DWC if they decline an appointment offer as a precautionary measure related to COVID-19.  Injured Employees to reschedule a designated doctor exam, contact the designated doctor listed on the appointment notice. Testing DWC’s designated doctor and MMI/IR certification testing vendor, PSI, has instituted enhanced procedures and test center closures in certain areas. Please visit the PSI website to find out more.
• Telemedicine - Injured employees may receive telemedicine and telehealth services in the Texas workers’ compensation system regardless of geographic location. To learn more, visit the TDI website.
• Carriers  Austin Representative Boxes - The carrier boxes at the Austin Metro office remain in use. Safety precautions, including disinfectant and strict use of the glass barrier, will be utilized.
• First Report of Injury - When reporting a claim, DWC requests that carriers clearly specify if a claim involves COVID- 19. This can be done in the incident description field on the first report of injury. This will help DWC monitor the impact of this event.
• For additional information please use the following contact information: Health care providers:   compconnection@tdi.texas.gov 800-252-7031, Option 3  Employers:  healthsafety@tdi.texas.gov 800-687-7080 512-804-4600, in Austin  Hearings: 512-804-4010  Media inquiries:  DWCCommunications@tdi.texas.gov  Injured employees:  800-252-7031, Option 1  To report a safety or health hazard: 800-452-9595safetyhotline@tdi.texas.gov  All other inquiries: DWCExternalRelations@tdi.texas.gov.  To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has adopted a new form: DWC Form-121, Claim Administration Contact Information. DWC posted a draft DWC Form-121 online for informal comments and considered all comments.  We request that insurance carriers, including certified self-insurers, certified self-insurer groups, and governmental entities, update their claim administration contact information using this form no later than April 27, 2020. We will use this form to verify that contact information for each insurance carrier is current.  28 Texas Administrative Code §124.2(r)(1) requires insurance carriers to provide contact information for:
  •   claims adjustment
  • coverage verification (policy issuance and effective dates of the policy)
  •   medical billing
  • pharmacy billing (if different from medical billing)
  •  preauthorization
• You must also submit DWC Form-121 to report new or updated claim administration contact information within 10 working days after making a change.    To get the form, go here: https://www.tdi.texas.gov/forms/form20numeric.html. To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.   Due to ongoing safety concerns with COVID-19, we are no longer able to perform in-person customer assistance at our field offices. But you can still get help with your claim at any time by calling DWC at 800-252-7031or OIEC at 866-393-6432.  
• The Texas Department of Insurance is coordinating with several state agencies on steps to help our state reduce the spread of COVID-19 and minimize potential regulatory burdens as you continue to serve your policyholders. This is a rapidly evolving, dynamic situation, and we will provide you with frequent updates on our activities. Here are some brief updates today:  We’re working to ease agent and adjuster licensing requirements and claim-related deadlines where possible. You’ll get more information on these efforts soon.  We’ve posted a list of office emails in case you have trouble reaching your normal agency contact by phone. We’ve also developed forms where you can get help with pending filing issues or ask questions. You’ll find both on our website.  Visit our coronavirus resource page for past messages and guidance to the industry. Most TDI staff are working remotely, and we continue to provide essential services, answer your questions, and work through issues as they develop. The work we’ve done over the last two years to modernize, reduce reliance on paper processes, and move our staff to laptops has been a tremendous help in this transition. We’ll update you frequently as new information becomes available.

REGULATORY ACTIVITY:

• Since 1991, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) has prescribed standard form interrogatories under Texas Labor Code §410.159. The form interrogatories have been adopted by reference under 28 Texas Administrative Code §142.19. The form interrogatories are formal sets of questions that are used during discovery prior to a hearing to obtain written responses from an opposing party. There are two sets of interrogatories: Claimant’s Interrogatories to Carrier; Carrier’s Interrogatories to Claimants.  DWC has initiated a review of the utility and sufficiency of the current interrogatory forms and is requesting comments and suggestions from stakeholders regarding updates or revisions. DWC will host a stakeholder meeting to discuss the interrogatories on Tuesday, March 31, 2020, at 10 a.m. in DWC’s Tippy Foster Room at 7551 Metro Center Drive, Suite 100, in Austin.  DWC provides reasonable accommodations for persons attending meetings, hearings, or educational events as required by the Americans with Disabilities Act. If you need accommodations, please contact Cynthia Guillen at 512-804-4275 or at RuleComments@tdi.texas.gov before 12 p.m., Central time, on Thursday, March 26, 2020. Written comments may be submitted to RuleComments@tdi.texas.gov, or by mail to Cynthia Guillen Legal Services, MS-4D Texas Department of Insurance, and Division of Workers' Compensation 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645. To view this notice, go to https://www.tdi.texas.gov/wc/index.html.
• The  Texas  Department  of  Insurance  proposes  to  amend  28  TAC §5.9332,  relating  to  workers'  compensation  classification  relativities.  The  amendment  is necessary because Senate Bill 1336, 86th Legislature, Regular Session (2019), eliminated the department's statutory requirement to develop workers' compensation classification relativities, which made paragraph (7)(B) of 28 TAC §5.9332 obsolete.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has adopted amendments to 28 Texas Administrative Code §129.5 (concerning Work Status Reports) to implement House Bill (HB) 387, 86th Legislature. These amendments conform to the amended statute, allowing a treating doctor to delegate authority to complete and sign a work status report to a licensed advanced practice registered nurse. The amendments are adopted without changes. The adopted rules will be published in the February 28, 2020, issue of the Texas Register and will be available at sos.state.tx.us/texreg/index.shtml once published. A courtesy copy is on the TDI website. DWC previously approved revisions to the DWC Form-073, Work Status Report, as the changes made by HB 387 went into effect on September 1, 2019. Advanced practice registered nurses have been authorized to sign work status reports since that date. The amended rule is effective March 1, 2020.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting public comment on a proposed new form: DWC Form-121, Claim Administration Contact Information. Insurance carriers, including certified self-insurers, certified self-insurer groups, and governmental entities will be required to use DWC Form-121 to provide new or updated claim administration contact information through their Austin representative. Insurance carriers must update this information within 10 working days after making a change. Texas Administrative Code, Title 28, Section 124.2(r) (1) requires insurance carriers to provide contact information for:
  • coverage verification (policy issuance and effective dates of policy);
  • claims adjustment;
  • medical billing;
  • pharmacy billing (if different from medical billing); and
  • pre-authorization

The proposed form is available on the TDI website. You may submit written comments on the form to RuleComments@tdi.texas.gov, or mail your comments to Cynthia Guillen Legal Services, MS - 4D Texas Department of Insurance, Division of Workers’ Compensation 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645.  The deadline to submit comments is 5 p.m., Central time, Thursday, February 27, 2020. To view the memo and draft form, go to https://www.tdi.texas.gov/wc/rules/drafts.html.

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has updated its English and Spanish plain language notices (PLNs) to show all text in 12-point font or larger. The instructions have also been changed to reflect recent DWC rule changes that require all PLNs sent by insurance carriers be in plain language and in no less than 12-point font as required by 28 Texas Administrative Code §124.2(s).     The new font size requirement is for PLNs sent on or after April 1, 2020.  The updated PLNs can be found on the DWC website at https://www.tdi.texas.gov/forms/form20plain.html.

FEE SCHEDULE NEWS:

• A new Home Health and Dental fee schedules have been updated with an effective date of January 1, 2020. The next expected update is in April 2020.

REGULATORY ACTIVITY:

• The division has established a web site regarding the recently enacted statute for reimbursement for federal military treatment facilities. The Texas Labor Code applies to services provided to injured employees at federal military treatment facilities (FMTF). With few exceptions, health care provided to an injured employee at an FMTF, on or after January 1, 2020, is paid at 100 percent of the billed charges. The web page provides vital information regarding the implementation of the new law and rule written in conjunction with the statute.  It provides guidance regarding the transmittal of the initial bill for a claimant treated at a military treatment facility to the state.  To view the information, go to https://www.tdi.texas.gov/wc/carrier/fmtfic.html.

REGULATORY ACTIVITY:

•  The Texas Department of Insurance, Division of Workers' Compensation (DWC) is readopting all sections within Chapters 102-116. This re-adoption complies with Texas Government Code §2001.039, requiring a state agency to review each of its rules every four years and to readopt, readopt with amendment, or repeal the rule. A notice of rule review was published in the July 19, 2019, issue of the Texas Register. DWC determined that the reasons for adopting the chapters continue to exist. The notice of re-adoption will be published in the December 13, 2019, issue of the Texas Register. Any repeals or suggested amendments identified during the review of these rules may be considered in future rulemaking. To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html
• Published the 2020 Performance Based Oversight Assessment Insurance Carriers Methodology. To view the published document, go to https://www.tdi.texas.gov/alert/whatsnew/index.html
• The Texas Department of Insurance, Division of Workers' Compensation (DWC) has released the 2019 Health Care Provider Performance Based Oversight (PBO) assessment. For 2019, health care providers were assessed on their performance in one of three categories: o timely filing of the DWC Form-069, Report of Medical Evaluation; o completeness of the DWC Form-073, Work Status Report; or o documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073, Work Status Report. DWC reviewed 97 health care providers for the timeliness of filing the DWC Form-069, Report of Medical Evaluation with the following results: 73 had scores placing them in the high performer tier, 18 were in the average performer tier, and six had scores placing them in the poor performer tier. DWC reviewed 113 health care providers for the completeness of the DWC Form-073, Work Status Report with the following results: 49 had scores placing them in the high performer tier, 28 were in the average performer tier, and 36 had scores placing them in the poor performer tier. DWC reviewed 113 health care providers for documentation supporting why the injured employee was prevented from returning to work, as reported on the DWC Form-073, Work Status Report with the following results: 55 had scores placing them in the high performer tier, 39 were in the average performer tier, and 19 had scores placing them in the poor performer tier. 
• The 2019 PBO assessment results and a list of the health care providers that were reviewed are posted on the TDI website. If a health care provider is not listed, they were not assessed in 2019; however, no health care provider in the Texas workers' compensation system is exempt from compliance with the Texas Labor Code and DWC rules. More information on PBO and the 2019 assessment are available on the TDI website. DWC will assess insurance carriers separately in 2020. To view the results, go to https://www.tdi.texas.gov/wc/pbo/pboresults.html .

FEE SCHEDULE NEWS:

• New Medical Fee Guideline conversion factors have been adopted with an effective date of January 1, 2020. For services provided in calendar year 2020, the new Medical Fee Guideline conversion factors are $60.32 and $75.70. The conversion factor of $60.32 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting. The conversion factor of $75.70 applies to surgery when performed in a facility setting.

REGULATORY ACTIVITY:

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) seeks input for the 2020 Medical Quality Review Annual Audit Plan; specifically, input regarding the proposal for categories within the annual plan.  The annual plan sets the priorities for the Medical Quality Review Panel (MQRP) audits during the upcoming year. This includes the scope, methodology, selection criteria, and program area responsibilities described in the Medical Quality Review Process. Information about the process and the proposed annual plan is on the TDI website at tdi.texas.gov/wc/hcprovider/medadvisor.html.   The medical advisor is responsible for developing the annual plan, which is adopted by the commissioner of workers’ compensation. The medical advisor evaluates annual plan suggestions using the following criteria:
  • Does it relate to the responsibility of the medical advisor or the MQRP under Texas Labor Code §§413.0511 and 413.0512? (e.g., the quality of health care provided by doctors or other health care providers treating injured employees; or the quality and timeliness of decisions made by utilization review agents, insurance carriers, designated doctors, or independent review organizations).
  • Is the data to select audit participants available to DWC, or is it easily obtained and reasonable to complete the audit?
  • Does DWC have enough resources to complete the audit within the calendar year?

You can submit suggestions for this proposed annual plan by email to OMA@tdi.texas.gov by 5 p.m., Central time on Friday, December 6, 2019.

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has adopted a new form: DWC Form-029, Request for Standard Detailed Data Reports, effective November 4, 2019. DWC posted the draft DWC Form-029 online on August 23 and did not receive any comments. Insurance carriers, including certified self-insurers, certified self-insurer groups, and governmental entities, may submit the new form to ask for claim-level data they have already submitted to DWC. The data will be made available to them or another entity on their behalf through a secure file transfer protocol (SFTP) box. The reports provide the detail related to the insurance carrier performance scorecards for:
  • timely payment of initial temporary income benefits and EDI reporting;
  • timely processing of medical bills and EDI reporting; and
  • timely processing of reconsideration medical bills and EDI reporting.

Requests for standard detailed data reports through DWC’s open records portal will continue to be accepted until Monday, December 2, at which time requestors will be directed to use the new form and SFTP process.   To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.  To view the form, go to https://www.tdi.texas.gov/forms/form20numeric.html.

• The Texas Department of Insurance, Division of Workers’ Compensation is asking for input on the 2020 Insurance Carrier PBO Assessment and the 2021 Health Care Provider PBO Assessment.  The methodology papers set the measures, scope, selection, tier structure, placement, and assessment process. Copies of the proposed 2020 and 2021 PBO Assessment methodology papers are on the TDI website.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting comments on proposed amendments to 28 Texas Administrative Code (TAC) §129.5 to implement House Bill (HB) 387, 86th Legislature. HB 387 amends Texas Labor Code §408.025(a-1) to include licensed advanced practice registered nurses as the persons to whom a treating doctor may delegate the authority to complete, sign, and file a work status report (DWC Form-073) and became effective September 1, 2019.  Proposed 28 TAC §129.5 will:
  • conform DWC rules to HB 387, allowing a treating doctor to delegate authority to complete, sign, and file a work status report to a licensed advanced practice registered nurse;
  • provide that the delegating treating doctor is responsible for the acts of the licensed  advanced practice registered nurse under Labor Code §408.025(a-1) and Texas Occupations Code Chapter 301, Nurses; and
  • provide that the delegating treating doctor is responsible for the acts of the licensed  advanced practice registered nurse under Labor Code §408.025(a-1) and Texas Occupations Code Chapter 301, Nurses; and
  • include minor updates and editorial corrections.

The proposed rule was published in the October 11, 2019, issue of the Texas Register at 44 TexReg 5878 and is available at www.sos.state.tx.us/texreg/index.shtml.  A courtesy copy is also on the TDI website.  Written comments or public hearing requests may be submitted to RuleComments@tdi.texas.gov, or by mailing or delivering your comments to:  Cynthia Guillen, Office of the General Counsel, MS-4D Texas Department of Insurance, Division of Workers' Compensation, 7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1645.  DWC has extended the public comment period for the proposed rules. Comments must be received by 5 p.m., Central time, on Monday, December 23, 2019.  Any requests for a public hearing must be submitted by the comment deadline.  In conjunction with the proposed rule, Commissioner Brown has finalized revisions to DWC Form-073, Work Status Report. The revised DWC Form-073 includes a new box to allow licensed advanced practice registered nurses to complete and sign the form. DWC encourages system participants to continue accepting the prior DWC Form-073 through the end of the calendar year to allow doctors, licensed physician assistants, and licensed advanced practice registered nurses time to transition to the updated form.   To view this notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html. To view the rule, go to  https://www.tdi.texas.gov/wc/rules/2019rules.html.

• The Texas Department of Insurance, Division of Workers’ Compensation is accepting comments on the proposed Fiscal Year 2020 Research Agenda of the Workers’ Compensation Research and Evaluation Group (REG).  Comments or public hearing requests must be received in writing no later than 5 p.m., Central time, December 30, 2019.  Comments  may be submitted  by email to RuleComments@tdi.texas.gov, or by mail to:  Cynthia Guillen Office of the General Counsel, MS-4D Texas Department of Insurance, Division of Workers' Compensation 7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1645  The proposed agenda was published in the November 29, 2019, issue of the Texas Register and is available at sos.state.tx.us/texreg/index.shtml once published.  Copies of the proposed research agenda are at https://www.tdi.texas.gov/reports/wcreg/index.html#wcresearch.  To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is adopting rules to implement Senate Bill (SB) 935, 86th Legislature.   The rules establish requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility (FMTF), as well as a separate medical dispute resolution process designed to address disputes over charges billed by FMTFs. The change in law made by SB 935 applies to health care services provided to an injured employee on or after January 1, 2020, regardless of the date of injury.   Rule 134.150. Reimbursement of Services Provided by a Federal Military Treatment Facility:
  • Establishes applicability of rules in subsections (a)-(b).
  • Clarifies bill processing requirements in subsection (c)-(d).
  • Clarifies that an insurance carrier may only deny a medical bill based on medical necessity, compensability, extent of injury, or liability in subsection (e).
  • Requires carriers to report the first bill received from an FMTF to DWC.
  • Clarifies that unreported bills are subject to a request for information under Rule 102.9 in subsection (g).

Rule 134.155. Federal Military Treatment Facility Disputes:

• Provides that disputes for medical necessity will be adjudicated under Rule 133.308, except that an injured employee may initiate a dispute,  may request reconsideration,  and the insurance carrier will be responsible for all independent review organization fees in subsection (a)(1).
• Provides that all other disputes will be handled under the existing process for benefit review conferences in subsection (a) (2).
• Notes that a first responder may request expedited dispute resolution in subsection (c).

The adopted rules will be published in the December 6, 2019, issue of the Texas Register and will be available at www.sos.state.tx.us/texreg/index.shtml  once published. A courtesy copy is on the TDI website.  As required under Rule 134.150 (f), insurance carriers are required to report the first bill received from an FMTF to DWC. Instructions about where to submit the first bill can be found on the TDI website.

REGULATORY ACTIVITY:

• On Monday September 30, TDI-DWC released its 2019 Workers' Compensation Network Report Card Results. The report was prepared by the Workers’ Compensation Research and Evaluation group (WCREG) and compares the quality, costs, health care provider availability, and other factors of workers' compensation health care networks with each other and with medical care provided outside of networks.  As background, TDI began certifying workers’ compensation healthcare in 2006 and as of June 1, 2019, there are now 30 certified networks covering all 254 Texas counties. Among the report highlights:
  • For 2019, 48% of new claims are being treated in a network
  • Average medical costs at 18 months remain lower in network than non-network ($3091 v $3396)
  • Return-to-work rates are high in both network and non-network but slightly higher in network (94% v 90%)
  • Injured workers being treated in a network reported higher satisfaction with care

• Published an update on recent legislative changes. To view the update, go to https://www.tdi.texas.gov/alert/whatsnew/index.html.
• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting public comments on proposed amendments to 28 Texas Administrative Code (TAC) §§2, 124.3, 180.8, and 180.26 to implement Senate Bill 2551, 86th Legislature. These amendments involve process changes for claims that may qualify for a presumption under Texas Government Code, Chapter 607, Subchapter B.  Editorial corrections are made throughout these rules to provide clarity and to align with current agency style.   To view the notice, go to https://www.tdi.texas.gov/alert/whatsnew/index.html. To view the proposed rules, go to https://www.tdi.texas.gov/wc/rules/drafts.html.