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You are here: Home . rules . 2008 . 0305a-059

SUBCHAPTER H. Examinations

28 TAC §10.200

1. INTRODUCTION.

The Commissioner of Insurance adopts new §10.200, concerning Fee for Examination of a Certified Workers' Compensation Health Care Network. The new section is adopted without changes to the proposed text published in the December 28, 2007 issue of the Texas Register (32 TexReg 9920).

2. REASONED JUSTIFICATION. The new section is necessary to implement SB 1253, 80th Legislature, Regular Session. SB 1253 amended Insurance Code §1305.251 to require a certified workers' compensation health care network (network) to pay a fee for Department examinations conducted under §§1305.251 (relating to examination of networks) or 1305.252 (relating to general standards for retrospective review) in an amount set by the Commissioner and in accordance with rules adopted by the Commissioner. Pursuant to §1305.252(c), the fee is to be paid for the expenses of an examination that are incurred by the Commissioner or under the Commissioner's authority and that are directly attributable to that examination, including the actual salaries and expenses of the examiners directly attributable to that examination.

Additionally, the new section is necessary to establish matters the Commissioner will consider to determine the amount of the fee to be paid by a network for the expense of an examination conducted under Insurance Code §§1305.251 or 1305.252, and the new section is necessary to specify the time in which such a fee must be paid.

3. HOW THE SECTION WILL FUNCTION. Adopted §10.200(a) provides that in accordance with Insurance Code §1305.251, a network shall pay to the Department an examination fee for expenses directly attributable to an examination of the network conducted pursuant to Insurance Code §§1305.251 or 1305.252.

Adopted §10.200(b) specifies that the examination fee shall consist of the actual salary and expenses of the examiners directly attributable to the examination. Adopted §10.200(b)(1) describes how to calculate the part of an examiner's salary included in the examination fee, and adopted §10.200(b)(2) describes the expenses included in the examination fee.

Adopted §10.200(c) requires that an examination fee paid pursuant to the section be payable and due to the Texas Department of Insurance, P.O. Box 149104, Mail Code 108-3A, Austin, Texas 78714-9104, no later than 30 days from the invoice date.

4. SUMMARY OF COMMENTS. The Department did not receive any comments on the proposed new section.

5. STATUTORY AUTHORITY. The new section is adopted under the Insurance Code §§1305.251, 1305.007, and 36.001. Section 1305.251 requires a certified workers' compensation health care network to pay a fee to the Department, in an amount set by the Commissioner and in accordance with rules adopted by the Commissioner, for the expenses of an examination conducted under §1305.251 or §1305.252 that are incurred by the Commissioner or under the Commissioner's authority and are directly attributable to that examination, including the actual salaries and expenses of the examiners directly attributable to that examination, as determined under rules adopted by the Commissioner. Section 1305.007 provides that the Commissioner may adopt rules as necessary to implement Insurance Code Chapter 1305, the Workers' Compensation Health Care Networks Act. Section 36.001 provides that the Commissioner may adopt any rules necessary and appropriate to implement the powers and duties of the Texas Department of Insurance under the Insurance Code and other laws of this state.

6. TEXT.

Subchapter H. Examinations.

§10.200. Fee for Examination of a Certified Workers' Compensation Health Care Network.

(a) As provided in Insurance Code §1305.251, a network shall pay to the department an examination fee set by the Commissioner for expenses directly attributable to an examination of the network conducted pursuant to Insurance Code §§1305.251 or 1305.252.

(b) The examination fee shall include the actual salary and expenses of the examiners directly attributable to the examination.

(1) The actual salary of an examiner is determined by dividing the annual salary of the examiner by the total number of working days in a year, then dividing that amount by the number of hours in a working day. The actual salary included in an examination fee shall be the part of the annual salary attributable to each hour the examiner examines the network.

(2) The expenses included in an examination fee shall be those actually incurred by the examiner and directly attributable to the examination, including the actual cost of:

(A) transportation,

(B) lodging,

(C) meals,

(D) subsistence expenses,

(E) parking fees, and

(F) department overhead expense.

(c) An examination fee paid pursuant to this section shall be payable and due to the Texas Department of Insurance, P.O. Box 149104, Mail Code 108-3A, Austin, Texas 78714-9104, no later than 30 days from the invoice date.



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