New 28 TAC §134.239 does not include unnecessary capitalization to conform to current agency style.

New 28 TAC §134.239 does not include the phrase "subsections (i) and (j) of this section" and instead includes the phrase "§134.240 and §134.250 of this title" because new 28 TAC §134.240 and §134.250 reflects the content of existing 28 TAC §134.204(i) and (j).

New 28 TAC §134.239 does not include the title of the referenced rule citation in existing 28 TAC §134.204(l) "(relating to Work Status Reports)" to conform to current agency style.

New 28 TAC §134.240. New 28 TAC §134.240 addresses the medical fee guideline for designated doctor examinations. New 28 TAC §134.240 largely mirrors existing 28 TAC 134.204(i), with non-substantive changes. New 28 TAC §134.240 includes the title "Designated Doctor Examinations" because the title reflects the content of this section.

New 28 TAC §134.240 does not include a subsection "(i)" because new 28 TAC §134.240 is an independent section that contains an implied subsection and the lettering is no longer necessary to conform to Texas Register requirements.

New 28 TAC §134.240 does not include unnecessary capitalization to conform to current agency style.

New 28 TAC §134.240(1)(A) - (B) does not include the phrase "subsection (j) of this section" and instead includes the phrase "§134.250 of this title" because new 28 TAC §134.250 reflects the content of existing 28 TAC §134.204(j).

New 28 TAC §134.240(1)(C) - (F) and (2)(A) - (C) do not include the phrase "subsection (k) of this section" and instead includes the phrase "§134.235 of this title" because new 28 TAC §134.235 reflects the content of existing 28 TAC §134.204(k).

New 28 TAC §134.240(2) does not include the word "subsection" and instead includes the word "section" because new 28 TAC §134.240 is an independent section.

New 28 TAC §134.250. New 28 TAC §134.250 addresses the medical fee guideline for maximum medical improvement evaluations, and impairment rating examinations. New 28 TAC §134.250 largely mirrors existing 28 TAC 134.204(j), with non-substantive changes. New 28 TAC §134.250 includes the title "Maximum Medical Improvement/Impairment Rating Examinations" because the title reflects the content of this section.

New 28 TAC §134.250 does not include a subsection "(j)" because new 28 TAC §134.250 is an independent section that contains an implied subsection and the lettering is no longer necessary to conform to Texas Register requirements.

New 28 TAC §134.250 does not include unnecessary capitalization to conform to current agency style.

New 28 TAC §134.250(1) includes the phrase "maximum allowable reimbursement (MAR)." The non-substantive change is necessary for clarity.

New 28 TAC §134.250(1)(D) does not include unnecessary punctuation to conform to current agency style.

New 28 TAC §134.250(1)(E) does not include the phrase "Act and Division rules in" and instead includes the phrase "Labor Code and" to conform to current agency style.

New 28 TAC §134.250(1)(E) does not include the title of the referenced rule citation in existing 28 TAC §134.204(j)(1)(E) "(relating to Impairment and Supplemental Income Benefits)" to conform to current agency style.

New 28 TAC §134.250(2) does not include the phrase "An HCP" and instead includes the phrase "A health care provider." The non-substantive change is necessary for clarity.

New 28 TAC §134.250(2) does not include the phrase "Act and Division rules in" and instead includes the phrase "Labor Code and" to conform to current agency style.

New 28 TAC §134.250(2)(A) - (C) and (3)(B)(i) - (ii) does not include the word "subsection" and instead includes the word "section" because new 28 TAC §134.250 is an independent section.

New 28 TAC §134.250(3)(A)(ii) corrects punctuation to conform to current agency style.

New 28 TAC §134.250(3)(B) and (3)(B)(i) do not include unnecessary punctuation to conform to current agency style.

New 28 TAC §134.250(4)(A) does not include the abbreviation "HCP" and instead includes the phrase "health care provider." The non-substantive change is necessary for clarity.

New 28 TAC §134.250(4)(B) does not include the citation §130.6 because the citation 28 TAC §130.6 is obsolete.

New 28 TAC §134.250(4)(B) does not include the title of the referenced rule citation in existing 28 TAC §134.204(j)(4)(B) "(relating to Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings)" to conform to current agency style.

New 28 TAC §134.250(4)(C)(ii)(I) does not include the numeral "4th" and instead includes the word "fourth" to conform to current agency style.

New 28 TAC §134.250(4)(C)(iv) does not include the title of the referenced rule citation in existing 28 TAC §134.204(j)(4)(C)(iv) "(relating to Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment)" to conform to current agency style.

New 28 TAC §134.250(4)(C)(v) does not include the abbreviation "HCP" and instead includes the phrase "health care provider." The non-substantive change is necessary for clarity.

New 28 TAC §134.250(5) does not include the word "subsection" and instead includes the word "section" because new 28 TAC §134.250 is an independent section.

New 28 TAC §134.250(6) does not include the phrase "Act and Division Rules" and instead includes the phrase "Labor Code and" to conform to current agency style.

SUMMARY OF COMMENTS AND AGENCY RESPONSE.

General

Comment: A commenter requests the division consider increasing reimbursements for participating designated doctors as necessary to safekeep the current process. The commenter also requests the division consider a fee of $100.00 for no-show appointments when an injured employee fails to show for a designated doctor exam. The commenter states that there are a lot of hours and sacrifice involved to do a competent and complete job.

Agency Response: The division declines to make the suggested change. The commenter's request is considered substantive and outside the scope of the non-substantive reorganization of 28 TAC §134.204.

Comment: A commenter states that part of 28 TAC §127.10(a)(3) (regarding General Procedures for Designated Doctor Examinations) does not read as intended and requests the division to delete the phrase "within one working day of the examination" and add the phrase "at least one working day prior to the examination."

Agency Response: The division declines to make the suggested change. The commenter's request relates to 28 TAC Chapter 127 and is outside the scope of the non-substantive reorganization of 28 TAC §134.204.

28 TAC §134.204 and 28 TAC §134.210

Comment: A commenter requests a CPT code in the division-specific modifiers section of 28 TAC §134.204(n)(5) and 28 TAC §134.210(e)(5) be changed.

Agency Response: The division appreciates the comment but declines to make the suggested change at this time because the request is considered a substantive change and outside the scope of the non-substantive reorganization 28 TAC §134.204.

28 TAC §134.250

Comment: A commenter questions why a $50.00 reimbursement for incorporating a specialist's report in the final assignment of an impairment rating is allowed only for non-musculoskeletal body areas. The commenter requests that a designated doctor be reimbursed when incorporating the findings of all types of additional testing into the maximum medical improvement and/or impairment rating report, and requests the division remove "non-musculoskeletal" from the rule.

Agency Response: The division declines to make the suggested change. The commenter's request is considered substantive and outside the scope of the non-substantive reorganization 28 TAC §134.204.

NAMES OF THOSE COMMENTING FOR AND AGAINST THE PROPOSAL

For: None

For with changes: None

Against: None

Neither for nor against: Two individuals

The amendments and new sections are adopted under Labor Code §§402.00111, 402.061, 408.021, 408.0252, 413.002, 413.007, 413.011, 413.012, 413.013, 413.014, 413.015, 413.016, 413.017, 413.019, 413.031, and 413.0511.

Labor Code §402.00111 requires the commissioner of workers' compensation to exercise all executive authority, including rulemaking authority, under Title 5 of the Labor Code. Labor Code §402.061 requires the commissioner of workers' compensation to adopt rules as necessary for the implementation and enforcement of the Texas Workers' Compensation Act. Labor Code §408.021 provides that an injured employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed. Labor Code §408.0252 permits the commissioner to identify areas of this state in which access to health care providers is less available and may adopt appropriate standards, guidelines, and rules regarding the delivery of health care in those areas. Labor Code §413.002 requires the division to monitor health care providers, insurance carriers, independent review organizations, and workers' compensation claimants who receive medical services to ensure the compliance of those persons with rules adopted by the commissioner relating to health care, including medical policies and fee guidelines. Labor Code §413.007 requires the division to maintain a statewide database of medical charges, actual payments, and treatment protocols that may be used in adopting and administering the medical policies and fee guidelines. Labor Code §413.011 requires the commissioner to adopt health care reimbursement policies and guidelines that reflect the standardized reimbursement structures found in other health care delivery systems and the fee guidelines must be fair and reasonable and designed to ensure the quality of medical care and to achieve effective medical cost control. The guidelines may not provide for payment of a fee in excess of the fee charged for similar treatment of an injured individual of an equivalent standard of living and paid by that individual or by someone acting on that individual's behalf. Labor Code §413.012 requires the division to review and revise the medical policies and fee guidelines at least every two years to reflect fair and reasonable fees and to reflect medical treatment or ranges of treatment that are reasonable or necessary at the time the review and revision is conducted. Labor Code §413.013 requires the commissioner to establish programs related to health care treatments and services for dispute resolution monitoring and review to ensure compliance with medical policies or guidelines. Labor Code §413.014 requires the commissioner to specify which health care treatments and services require preauthorization or concurrent review by insurance carriers. Labor Code §413.015 requires the commissioner to review and audit insurance carriers payments of charges for medical services to ensure compliance of medical policies and fee guidelines adopted by the commissioner. Labor Code §413.016 requires the division to order a refund of charges paid to a health care provider in excess of those allowed by the medical policies or fee guidelines and investigate the potential violation. Labor Code §413.017 provides for a presumption of reasonableness for medical services consistent with the medical policies and fee guidelines. Labor Code §413.019 provides for payment of interest on delayed payments, refunds, or overpayments. Labor Code §413.031 provides for medical dispute resolution for a medical service provided. Labor Code §413.0511 requires the medical advisor to make recommendations regarding the adoption of rules and policies to develop, maintain, and review guidelines as provided by Labor Code §413.011.