State News : Texas

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Texas

STONE LOUGHLIN & SWANSON, LLP

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  512-343-1300

  512-343-1385

The Texas Division of Workers' Compensation has published an informal working draft of the rules necessary to implement newly-enacted section 413.0112 of the Act, referred to informally as the Brooke Army Medical Center (BAMC) Bill.

This new statute requires carriers to reimburse a federal military treatment facility (FMTF) the amount charged by the facility as determined under 32 C.F.R. Part 220.

The purpose of the statute is to prevent injured workers from being balance-billed by a FMTF for medical treatment when the carrier does not pay the FMTF’s billed charges.

Section 413.0112 also requires the commissioner to adopt rules necessary to implement this section, including rules establishing:

  1. requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility; and 
  2. a separate medical dispute resolution process to resolve disputes over charges billed directly to an injured employee by a federal military treatment facility.

The informal draft rules do the following:
 
Rule 134.150

  • Clarifies bill processing and handling requirements.
  • Clarifies that an insurance carrier may only deny a medical bill based on compensability, extent, liability, or medical necessity.
  • Creates obligations for medical bill reporting by an insurance carrier requiring submission of the first bill received from an FMTF.
  • Clarifies that unreported bills are subject to a request for information under Rule 102.9.
  • Provides for an administrative violation in subsection (h). 

Rule 134.155

  • Provides that disputes for medical necessity will be handled under Rule 133.308, that an injured employee may initiate a dispute, and that the insurance carrier will be responsible for all independent review organization fees.
  • Provides that all other disputes will be handled under the existing process for benefit review conferences.
  • Notes that a first responder may request expedited handling.

A stakeholder meeting was held on July 8, 2019 to discuss the informal draft rules.  The Division is required to adopt the rules necessary to implement section 413.0112 no later than December 1, 2019.

-  Copyright 2019,James M. Loughlin, Stone Loughlin & Swanson, LLP.