Performance Based Oversight (PBO)
As a regulatory agency, the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is required to monitor system participants’ compliance with the Texas Workers’ Compensation Act and Rules and to address noncompliant behavior. Compliance objectives are achieved through Performance Based Oversight (PBO), data monitoring, complaint resolution, entity audits, and when appropriate, enforcement actions.
As part of the overall compliance plan, Section 402.075 of the Texas Labor Code mandates the TDI-DWC to, at least biennially, assess the performance of insurance carriers and health care providers. Based on the performance assessment, insurance carriers and health care providers will be placed into regulatory tiers: poor performers, average performers, and consistently high performers. The TDI-DWC must then focus its regulatory oversight on the poor performers. Starting in 2010, the insurance carriers will be assessed in even numbered years (2010, 2012, etc.) and the health care providers will be assessed in odd numbered years (2011, 2013, etc.).
Download Overall 2012 Insurance Carrier Methodology Paper (Dec 2011)
Download Overall 2013 Health Care Provider Methodology Paper (June 2012)
What is the purpose of Performance Based Oversight (PBO)?
"House Bill 7, 79th Legislature, 2005 (Regular Session)" requires establishment of a performance-based oversight system that includes development of key regulatory goals for assessing insurance carriers and health care providers, tiering of insurance carriers and health care providers based on performance, and development of regulatory incentives to promote compliance. The TDI-DWC's regulatory resources will be focused more strategically on overall compliance issues and history affecting an insurance carrier or a health care provider, placing emphasis on system participants with continuing compliance problems in the workers’ compensation system.
The purpose of PBO is to:
- Encourage and rewards excellence and continuous improvement;
- Foster improved and timely communications;
- Establish performance objectives, measures and expectations; and
- Focus on results rather than prescriptive requirements.
Applicable Statute & Rules
PBO Key Regulatory Goals
· Key Regulatory Goals (pdf)
PBO Working Group
2012 Performance Based Oversight Working Group Members
For more information contact:
Last updated: 01/04/2013