DWC Commissioner Signs Emergency Rules to Implement Texas’ HB 7

November 7, 2005

The Texas Division of Workers’ Compensation announced that workers’ comp Commissioner Albert Betts has signed and submitted to the Texas Register emergency rules regarding medical billing timeframes and preauthorization pursuant to the authority granted in House Bill 7 adopted by the 79th Legislature.

The medical billing emergency rules implement HB 7’s expedited timeframes for submission of medical bills and a carrier’s audit of those bills. The rules also increase the initial reimbursement for services subject to audit from 50 percent to 85 percent of the maximum allowable reimbursement, the contracted rate, or the billed amount as appropriate. The time frames are exactly as presented in HB 7. These emergency rules were effective Nov. 3, 2005.

The preauthorization emergency rule amends the existing rule to accommodate a new application for preauthorization as prescribed by Texas Labor Code Section 408.0042 (regarding Medical Examination By Treating Doctor To Define Compensable Injury). The preauthorization emergency rule includes the additions of physical therapy (PT) and occupational therapy (OT) to the list of services requiring preauthorization. Under the emergency preauthorization rule, PT/OT services will require preauthorization when rendered on or after December 1, 2005. An exception is provided for the initial two PT/OT visits following evaluation when certain conditions are met.

Emergency rules are effective for 120 days from the date filed with the Texas Register. The rules may be extended once for 60 days.

In the near future, informal drafts of permanent rules will be published by the Division to address both preauthorization and medical billing timeline requirements. To view the emergency rules, go to www.tdi.state.tx.us/wc/indexwc.html under “Rules.”

The DWC also reported the reopening of its Beaumont office on Nov. 7. All administrative proceedings (Benefit Review Conferences and Contested Case Hearings) will resume as scheduled on, Nov. 14.

The Beaumont field office was closed due to damage caused by Hurricane Rita, which hit Texas and Louisiana in September. Injured workers in the Beaumont area who need assistance can contact the DWC by calling (800) 372-7713 or (800) 252-7031.

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