Performance Based Oversight (PBO)
Contents:
What Is PBO? | Purpose Of PBO | Applicable Statute & Rules | PBO Planning Documents
What is 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 correct 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 Labor Code mandates TDI-DWC to, at least biennially, assess the performance of insurance carriers and health care providers in meeting the key regulatory goals established by the Commissioner of Workers’ Compensation. The key regulatory goals align with the general regulatory goals of TDI-DWC such as improving workplace safety and return-to-work outcomes, supporting timely payment of benefits, and increasing communications among system participants.
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. 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 2011 Health Care Provider Methodology Paper (June 2010)
What is the purpose of Performance Based Oversight (PBO)?
"H.B. 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 participants with continuing compliance problems in the workers’ compensation system.
The purpose of PBO is to:
- Encourages and rewards excellence and continuous improvement
- Fosters improved and timely communications
- Establishes performance objectives, measures and expectations
- Focuses on results rather than prescriptive requirements
Applicable Statute & Rules
Texas Labor Code §402.075 Incentives; Performance-Based Oversight
28 Texas Administrative Code (TAC) §180.19 Incentives
PBO Planning Documents
PBO Key Regulatory Goals
· Key Regulatory Goals (pdf)PBO Intruments
· Potential Assessment Measures Instrument (pdf)
· DWC Available Data (pdf)PBO Meetings
PBO Meetings
2012 PBO Meetings Date Agenda Notes 2/1/2012
2011 PBO Meetings Date Agenda Notes 7/27/2011 8/10/2011 8/12/2011 9/7/2011 9/21/2011 10/5/2011 PBO Working Group
2012 Performance Based Oversight Working Group Members
For more information contact:
Last updated: 02/06/2012
