| (a) Disputes over charges billed by a federal military
treatment facility (FMTF):
(1) If an insurance carrier denies payment of a medical
bill based on medical necessity, the medical necessity dispute shall
be initiated under §133.308 of this title (concerning MDR of
Medical Necessity Disputes):
(A) Notwithstanding Chapter 133, Subchapter D, of this
title (concerning Dispute of Medical Bills), an injured employee is
not required to request reconsideration prior to requesting medical
dispute resolution;
(B) Notwithstanding §133.308(f)(2)(B), an injured
employee may be a requestor in a medical necessity dispute, and
(C) Notwithstanding §133.308(q), the insurance
carrier shall pay all independent review organization fees.
(2) For all other disputes, a party may request a benefit
review conference as described under Chapter 141 of this title (concerning
Dispute Resolution--Benefit Review Conference).
(b) Except as provided in this section, an FMTF dispute
will be conducted in accordance with the division's rules for dispute
resolution in §133.308 or Chapters 140 - 147 of this title.
(c) In accordance with Labor Code §504.055 (relating
to Expedited Provision of Medical Benefits for Certain Injuries Sustained
by First Responders in Course and Scope of Employment) a request for
an FMTF dispute that involves a first responder's request for payment
of medical expenses will be accelerated by the division and given
priority. A first responder shall provide notice to the division that
the request involves a first responder.
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