Prospective Review of Texas Medical Care Rule to be Repealed

June 12, 2007

As the result of the adoption of treatment guidelines for the workers’ compensation system, the Texas Department of has announced that the prospective review of medical care not requiring preauthorization (PRM) rule (28 Texas Administrative Code ยง134.650) is no longer needed and will be repealed.

For recommended treatment that is not covered by, or is outside of, the Official Disability Guideline (ODG) treatment guidelines, health care providers must request preauthorization through the workers’ compensation insurance carrier. TDI’s preauthorization medical dispute resolution process is available if providers dispute a preauthorization denial by the carrier.

A repeal of the PRM rule will be submitted to the Texas Register. TDI will continue to accept PRM requests through June 18, 2007. However, as of May 1, 2007, workers’ compensation system participants are required to follow the treatment guidelines and request preauthorization if necessary.

TDI adopted rules in December 2006 which designated the ODG as the official workers’ compensation treatment guidelines for Texas. The treatment guidelines are applicable for health care provided on or after May 1, 2007.

Source: Texas Department of Insurance

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