- Prohibits waiver of workers' compensation rights. This
measure restored the law overturned by the Texas Supreme Court,
which prohibited employers from requiring employees as a
condition of employment to waive their workers' compensation
rights in exchange for health and indemnity benefits.
- Establishes statutorily a medical advisor position at the
Texas Workers' Compensation Commission (TWCC).
- Establishes a Medical Quality Review Panel consisting of
health care providers to advise the commission and the medical
advisor on health care issues.
- Requires that the medical director of a utilization review
entity have a Texas medical license and that physician reviewers
be on the approved doctor list.
- Increases authority of the commission to sanction and oversee
carriers and utilization review activities.
- Creates an approved physician list for which application is
made by providers to the commission.
- Requires that medical necessity disputes be resolved by an
independent review organization (IRO) paid for by the insurance
- Preauthorization replaces second opinion requirement for
spinal surgery, and disputes go to the IRO and are to be paid for
by the carrier.
- Requires the commission to develop criteria to decrease the
utilization review of providers and develop criteria for greater
monitoring of those who unreasonably over-utilize or
under-utilize health care services.
- Requires carriers to pay for prescription drugs and
over-the-counter medications in the first seven days after the
injury if there is verification of injury from either the
employer or the carrier.
- Requires treatment guidelines adopted by the commission to be
nationally recognized, scientifically proven and
- Provides for voluntary networks to be established, with
participation by the injured worker to be voluntary. The worker
can choose to stay within the workers' compensation system or
participate in a network and can opt out of the network up until
either receiving care or 14 days after injury, whichever is
earlier. The network is governed by a board that includes health
- Requires the use of the relative value units from the
Medicare Resource-Based Relative Value Scale (RBRVS) system for
fee guidelines but conversion factors still based upon the "fair
and reasonable fee" standard, and expressly prohibits the
adoption of the Medicare fee schedule.
- Places greater emphasis on insurers and employers to develop
return-to-work programs for injured workers.
When HB 2600 became the statutory vehicle for the use of an
RBRVS fee schedule by the workers' compensation program, TMA
vigorously sought provisions which specifically
the adoption of the Medicare RBRVS fee schedule, and which require,
through the use of appropriate conversion factors, the adoption of
fees that are "fair and reasonable." Prior to TMA's aggressive
advocacy with the Workers' Compensation Research and Oversight
Council and the commission, the objective of many legislators and
TWCC was to deliver maximum "savings" in workers' compensation
outlays by establishing a fee schedule below current commercial
levels and, if possible, below Medicare.
Even before this important reimbursement system issue became a
legislative initiative, TWCC began to look at the use of the
Medicare fee schedule as part of its administrative charge to
regularly update the workers' compensation fee schedule TMA
language ultimately adopted by the legislature requires the use of
an RBRVS that is
not the Medicare fee schedule per se
, incorporates the most current relative values, retains the
flexibility to develop non-Medicare conversion factors reflecting
Texas costs and conditions, and requires the use of fees that are
"fair and reasonable."
Workers' Compensation TMA Staff Contacts
Rich Johnson, Director, Division of Medical Economics,
Pat Coffey, Director, Office of Payment Advocacy, (512)
Health Care Funding
Long-Term Care and End-of-Life
Market Fairness/Managed Care
Medical Licensure and
Public Health and Science
Scope of Practice
Tort Reform/Medical Liability