|(a) This section applies, regardless of the date of
injury, to medical services provided on or after January 1, 2020,
in a federal military treatment facility (FMTF) as defined in Labor
Code §413.0112(a) (relating to Reimbursement of Federal Military
(b) Reimbursement for medical services provided to
an injured employee shall be the amount of the FMTF's charges as determined
under Title 32, Code of Federal Regulations, Part 220 (concerning
Collection of Reasonable Charges for Healthcare Services). Additionally,
charges may include interest, administrative penalties, or collection
fees related to medical benefits.
(c) An FMTF is not required to comply with health care
provider billing or preauthorization requirements in Chapters 133
(concerning General Medical Provisions) and 134 (concerning Benefits--Guidelines
for Medical Services, Charges, and Payments) of this title. An insurance
carrier shall process a medical bill from an FMTF and make payment
in accordance with Chapters 133 and 134, except as provided in Labor
Code §413.0112. The insurance carrier shall contact the FMTF
to obtain any information necessary to process a medical bill and
document the name and telephone number of the person who supplied
(d) Notwithstanding the requirements of Chapter 133,
an insurance carrier shall process professional and institutional
medical services submitted on a single bill by an FMTF. An insurance
carrier shall identify reimbursement for professional and institutional
services separately on the explanation of benefits form.
(e) The insurance carrier may only deny payment of
medical services provided by an FMTF for reasons of medical necessity,
compensability, extent of injury, or liability.
(f) An insurance carrier shall forward to the division,
within 14 calendar days of receipt, in the form and manner prescribed
by the division, the first medical bill for an injured employee that
it receives from an FMTF.
(g) An insurance carrier shall report FMTF medical
bills in accordance with Chapter 134, Subchapter I, of this title.
FMTF medical bills are subject to §102.9 of this title (concerning
Submission of Information Requested by the Commission) including medical
bills not reported in accordance with §134.806(a)(3) (concerning
Records Excluded from Reporting).