Labor Readies for Mandatory Comp Effort
Bills Target Third Party Administrators, Fee Issues
ODG Wins Treatment Guideline Debate in Texas

Labor Readies for Mandatory Comp Effort
Organized labor hopes the 2007 Legislature will make workers' compensation coverage mandatory for Texas employers.

But that proposal will encounter opposition as it has many times before -- from business employers.

In its legislative goals for 2007 released before the start of lawmakers' 140-day regular session today, the Texas AFL-CIO noted that Texas has "the only system in the nation that is not mandatory for employers."

To strengthen the system on behalf of all workers, the Texas AFL-CIO supports efforts to make workers' compensation mandatory, the AFL-CIO goals stated.

"In the alternative, we will support efforts to curb the most blatant abuses suffered by injured workers at the hands of employers who do not carry workers' compensation and to stiffen the penalties for noncompliance with notice and reporting requirements."

When asked by WorkCompCentral about potential sponsors for legislation for workers' compensation, Texas AFL-CIO legal director Rick Levy said it was "still early in terms of a formal battle plan."

"But we are definitely going to be moving things in that that direction," Levy said.

The Texas Association of Business, the state's most prominent organization representing employers, continues to oppose mandatory workers' compensation.

Association president Bill Hammond said his organization's members believe there are "very good programs available" throughout the state to nonsubscribing employers.

"We think employers should have the option of choosing those programs," Hammond said.

The labor goals noted that the 2005 session passed "a major rewrite of the Texas workers' compensation law" as HB 7, including authority for the Texas Department of Insurance to certify workers' compensation health care networks for treatment of injured workers.

"The Texas AFL-CIO has been active in working to ensure that the law is implemented in a way that is fair and true to the intent of the authors. In the course of that process, it has become clear that there are some issues that still need to be addressed in the 80th Legislature."

Among those issues is that "the network medical model has not afforded sufficient choice to injured workers," the AFL-CIO goals stated.

"The Texas AFL-CIO will support legislation that directs and employers the Texas Department of Insurance to require greater choice."

Hammond said his association would like to see the network approval process "speeded up" to allow more employers to take advantage of the network option.

The labor organization also wants legislation to increase benefits for injured workers.

"Research has shown that benefits have not kept pace with inflation, and that injured workers are at risk of falling further behind. Efforts to raise benefits significantly last session stalled. Insurance company profits are at very high levels. It is time to pass on some of the benefits of reform to injured workers," the group reported.

The Texas AFL-CIO also stated its intent to "monitor all workers' compensation legislation with an eye toward keeping injured workers as the focus of a system that treatments them with fairness and dignity."
By Bill Kidd, WorkCompCentral Correspondent
 

Bills Target Third Party Administrators, Fee Issues
Rep. Burt Solomons, R-Carrollton, filed three bills dealing with workers' compensation issues, including bringing workers' compensation third party administrators under Texas Department of Insurance licensing and clarifying fee issues for non-network care.

The legislation also would implement a recommendation by the Office of Injured Employee Counsel to allow ombudsmen assisting claimants in disputes to receive medical records without having to pay for them.

House Bill 472 would amend the current third party administrator law to upgrade some current requirements and to bring workers' compensation third party administrators under department licensing.

Currently, the Insurance Code covers third party administrators for annuities, life, health, accident and pharmacy benefits but does not include administrators dealing with workers' compensation.

The bill provides that administrators dealing with workers' compensation insurance and workers' compensation self-insurers are covered.

Third party administrators would be required to file an annual report on their activities with the insurance commissioner.

The measure also sets out grounds for disciplinary actions and penalties for practices which would be "hazardous or injurious to insured persons or the public."

To read HB 472, click here.

HB 473 would amend the medical fee guideline provisions in the Labor Code to clarify when an insurance carrier may contract with a provider for a fee different from the fee guideline for non-network care.

The bill provides that an insurance carrier may pay fees that exceed those set by the Division of Workers' Compensation to secure health care for an injured employee when "access to medically necessary and reasonable treatment for the injured employee is hindered by application of the fee guidelines" and the carrier or network has a contract including a specific fee schedule with the provider.

To read HB 473, click here.

HB 471 tracks a legislative recommendation from the Office of Injured Employee Counsel's legislative report regarding furnishing medical records to ombudsmen.

The bill provides that a health provider "shall provide copies" of an injured employee's medical records to the ombudsman assisting that employee "at no cost to the ombudsman or the office."

To read HB 471, click here.

The proposed bills would take effect immediately if approved by a two-thirds vote in both the House of Representatives and Senate and signed into law by the governor, or on Sept. 1 if they do not receive the votes needed for immediate effect.
Source: WorkCompCentral

ODG Wins Treatment Guideline Debate in Texas
Final rules announced late Friday make the Work Loss Data Institute's Official Disability Guidelines the standard for non-network care in Texas, despite strong opposition by the American College of Occupational and Environmental Medicine.

Debate over whether ODG or ACOEM should be the standard raged throughout much of 2006. The Texas Division of Workers' Compensation put an end to the dispute -- barring a legal challenge -- when Commissioner Albert Betts formerly adopted several rules dealing with disability management (Chapter 137) on Dec. 29. The regulations will be published in the Texas Register next Friday and will become effective Jan. 19.

The division said the new regulation sections, as well as chapter and subchapter title changes, are necessary to implement changes as a result of House Bill 7 enacted in 2005.

The final rules also adopt the Reed Group's Medical Disability Advisor as the state's return-to-work guidelines for non-network care. The Reed Group, ironically, had sided with ACOEM in the debate, perhaps not surprisingly since its founder, Dr. Presley Reed, is a member of the academy and wrote his return-to-work guidelines with ACOEM treatment recommendations in mind.

The DWC said in its announcement of the final rules that it "considered the merits of various published return to work guidelines and treatment guidelines."

Several stakeholder and work group meetings were held to discuss the disability management concept and rules related to guidelines, the division said. "Meetings were also held with nationally recognized guideline publishers.

"During a March 23, 2006, meeting, representatives of the various guidelines made presentations to division staff and workers' compensation system stakeholders regarding the development and use of their individual guidelines.

"The division reviewed and evaluated these guidelines, received stakeholder input, and considered the recommendations of the division's medical adviser and the former Texas Workers' Compensation Commission Medical Advisory Committee's Return to Work work group.

"Based on this review and input, the division made the selection of the most current edition of The Medical Disability Advisor, Workplace Guidelines for Disability Duration (MDA), as the division return to work guideline, and the most current edition of the Official Disability Guidelines-Treatment in Workers' Comp (ODG), published by Work Loss Data Institute (WLDI), as division treatment guidelines."

A detailed explanation on the rules and the division's responses to issues raised can be found here.
Source: Texas Division of Workers' Compensation
[top] [back to e-connect archive page]