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Texas seeks comment on new workers comp rules

Texas capital

The Texas Department of Insurance’s Division of Workers Compensation is seeking comment on informal rules it released on Thursday to implement a new law intended to protect injured employees who receive treatment at federal military facilities. 

On June 4, Texas Gov. Greg Abbott signed S.B. 935, which requires workers compensation insurance reimbursement rates for medical care provided at a federal military treatment facility to be the same rate provided by federal regulations. It also clarifies that medical care provided at these facilities is exempt from certain state workers compensation requirements involving billing and preauthorization. The law is slated to take effect Sept. 1.

According to the comp division, the agency asked lawmakers to address the issue after receiving complaints filed by injured workers billed for medical care at Brooke Army Medical Center in San Antonio. These injured workers had their bills turned over to federal debt collectors after 90 days because federal law requires military treatment facilities to collect reimbursement of all billed charges, with the balance going to the injured workers, said the division. 

“When our data showed that injured employees were being billed thousands of dollars for services they received, a red flag went up,” Cassie Brown, Texas’ workers compensation commissioner, said in a statement. “The basic premise of workers’ compensation insurance coverage in Texas is that injured employees receive benefits at no cost for compensable injuries, and in return, employers are protected from most lawsuits.”

The informal working rules stipulate that an insurer may only deny payment of medical services provided by an military treatment facility “for reasons of medical necessity, compensability, extent, or liability” and that insurers must forward to the Texas workers comp division — within 14 days of receipt —the first medical bill for an injured employee that it receives from a military treatment facility.

The proposed rules also dictate a timeline for disputes over changes billed by a military facility, require insurers to pay all independent review organization fees, and provides an expedited dispute resolution provision regarding medical benefits for certain injuries sustained by first responders.

The division is seeking comments on these proposed rules. The comment period ends July 15.


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