(a) - (f)(No change.)
(g)Requests. A request for independent review must
be filed in the form and manner prescribed by the department. The
department's IRO request form may be obtained from:
(1)the department's website at http://www.tdi.texas.gov/;
or
(2)the Managed Care Quality Assurance Office, Mail
Code LH-MCQA [103-6A], Texas Department of Insurance,
P.O. Box 12030 [149104], Austin, Texas 78711-2030
[78714-9104].
(h) - (t)(No change.)
(u)First Responders. In accordance with
Labor Code §504.055(d), an appeal regarding the denial of a claim
for medical benefits, including all health care required to cure or
relieve the effects naturally resulting from a compensable injury
involving a first responder will be accelerated by the division and
given priority. The party seeking to expedite the contested case hearing
or appeal must [shall] provide notice to the
division and independent review organization that the contested case
hearing or appeal involves a first responder.
(v)Texas Military Forces. In accordance
with Labor Code §501.028, the division will accelerate and give
priority to an appeal from a denial of a claim for medical benefits.
(1)This subsection applies to a claim for medical
benefits made by a member of the Texas military forces who, while
on state active duty, sustains a serious bodily injury, as defined
by Penal Code §1.07.
(2)The division will accelerate and give priority
to actions involving all health care required to cure or relieve the
effects naturally resulting from a compensable injury.
(3)The member must notify the division and IRO that
the CCH or appeal involves a member of the Texas military forces.
(w)[(v)] Enforcement. The department
or the division may initiate appropriate proceedings under Chapter
12 of this title or Labor Code, Title 5 and division rules against
an independent review organization or a person conducting independent
reviews.
The agency
certifies that legal counsel has reviewed
the proposal and found it to be within the state agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State on October 23, 2023
TRD-202303897 Kara Mace
General Counsel
Texas Department of Insurance, Division of Workers’ Compensation
Earliest possible date of adoption: December 3, 2023
For further information, please call: (512) 804-4703
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