Workers' Compensation Reform |
Access to Workers' Comp Claimant Information
| Guaranty Fund for Self-Insured Worker's Comp
| Temporary Employees Workers' Comp Benefits
At present, the Texas Workers' Compensation system ranks as one
of the most costly, least satisfactory, and least effective systems
in the country. Universally, all participants agree that the
system, in its current state, is one of disarray and frustration.
Physicians are refusing to treat workers' compensation patients
primarily because of the extremely high administrative hassles,
billing issues, and low reimbursement rates. In 2002, the Texas
Workers' Compensation Commission established a medical fee
guideline that pays physicians 125 percent of Medicare. In 2002,
approximately 30,000 physicians were willing to treat workers'
compensation patients; now, that number is about 12,000.
At this time, injured employees in Texas can choose any provider
(including a chiropractor or a dentist) to be their treating doctor
and may change providers as many times as they desire. These
issues, along with the adversarial nature of the workers'
compensation system, have created a system with high health care
costs, high employer premiums, low satisfaction for injured
workers, and very little incentive for injured employees to return
Workers' Compensation Reform
Of primary interest to physicians were HB 7 and SB 5, each with
major ramifications to the entire workers' compensation system. HB
7 by Rep. Burt Solomons (R-Carrollton) and SB 5 by Sen. Todd
Staples (R-Palestine) sought to dramatically revamp the faulty
system. HB 7, also known as the Sunset Commission's Workers'
Compensation Reform bill, is the result of the Sunset Commission's
periodic review of the Texas Workers Compensation Commission
(TWCC). SB 5 was the result of a large Senate interim study chaired
by Senator Staples.
Both bills attempted to reform workers' compensation health care
delivery through managed care-style networks to help control
utilization, the largest cost driver in the system, in exchange for
the ability of physicians to negotiate fees and a reduction in
administrative burdens. TMA consistently stated that networks were
not its idea nor did it believe they will be a "silver-bullet." TMA
stated that if the legislature decided that "networks" were to be
adopted, the same regulatory controls that exist for commercial
networks must apply to any workers' compensation network. These
controls include prompt pay language, networks adequacy language,
the ability to negotiate fees, and streamlined dispute
Both chambers handed out their respective workers' compensation
reform bills early on in the session. Upon arrival in the other
chamber, both bills came to a procedural halt. Without negotiation,
each bill was ultimately substituted for the other and sent to a
conference committee. Ultimately, intervention from the legislature
and governor was required to establish a compromise. The primary
issues of concern about both bills were who would be the final
author, whether or not the existing regulatory agency was retained,
and the level of benefits for injured workers.
HB 7 prevailed. The final version abolishes the Texas Workers'
Compensation Commission and transferred its regulatory authority to
a new division under the Texas Department of Insurance. The new
division will have a single gubernatorial-appointed commissioner
who reports directly to the insurance commissioner and governor. HB
7 also allows for managed care networks to deliver health care. The
networks will sign up providers, then monitor their utilization. In
theory, because these providers will be those chosen, trusted, and
monitored by the networks, the carriers will not impose many of the
unnecessary administrative burdens found in the existing system and
pay the providers fair and reasonable fees.
TMA-supported prompt pay language was included in the bill as
well as language dealing with network adequacy and due process.
Additionally, compensability determination and payment reform was
included in the final version. In an attempt to curb denial abuses,
carriers will be required to pay providers up to $7,000 if
providers successfully contest compensability.
Access to Workers' Comp Claimant Information
HB 251 by Rep. Rob Eisler (R-The Woodlands) and Sen. Tommy
Williams (R-Beaumont) allows employers, hospital groups, carriers,
and other affiliated groups to access workers' compensation
claimant information such as name, social security number, date of
birth, date of injury, injury type, and so forth. This measure
should affect insurance carriers much more than physicians. It will
give additional information to carriers and employers to address
Guaranty Fund for Self-Insured Worker's Comp Groups
HB 1353 by Rep. Robby Cook (D-Eagle Lake) and Sen. Robert Duncan
(R-Lubbock) creates a guaranty fund for self-insured workers'
compensation groups who are declared insolvent. The bill will set
up a trust fund of at least $1 million for the emergency payment of
the compensation liabilities of an insolvent group.
Temporary Employees Workers' Comp Benefits
HB 1745 by Rep. Gene Seaman (R-Corpus Christi) and Sen. John
Carona (R-Dallas) disqualifies certain temporary employees for
workers' compensation benefits.
Workers' Compensation TMA Staff Contacts:
- Greg Herzog, Legislative Affairs, (512) 370-1360
- Rich Johnson, Medical Economics, (512) 370-1315
- Michael Reed, Health Care Delivery, (512) 370-1409
- Donna Kinney, Regulatory Analysis and Advocacy, (512)
- C.J. Francisco, JD, Office of the General Counsel, (512)
Scope of Practice
Inadequate Health Plan Networks
Managed Care/Insurance Reform
Texas State Board of Medical
Examiners Sunset and Physician Licensure
Agency Sunset Review
Corporate Practice of Medicine
Health Care Funding
Medicaid and CHIP
Indigent Care and the
Professional Liability Reform
Child Health, Safety, and
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