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Adopted Rules

DISCLAIMER: The following adopted rules are provided as a courtesy by the Division of Workers' Compensation (DWC).  While DWC makes every effort to ensure the accuracy and completeness of this information, the official version of proposed and adopted rules are those filed with the Secretary of State, which is the repository of official DWC rules. Those rules can be accessed directly from the Texas Register, Office of Secretary of State. ( http://www.sos.state.tx.us/texreg/index.shtml ) With respect to the following documents, or other documents available from this site or others to which it links, DWC and the State of Texas make no warranty as to their accuracy, completeness, reliability, timeliness, and/or usefulness.


The following rule was adopted on March 7, 2014.  The rule will publish in the March 21, 2014 issue of the Texas Register. The rule is effective March 30, 2014.

CHAPTER 133:  GENERAL MEDICAL PROVISIONS
SUBCHAPTER A:  GENERAL RULES FOR MEDICAL BILLING AND PROCESSING
AMEND:  §133.2
SUBCHAPTER C:  MEDICAL BILL PROCESSING/AUDIT BY INSURANCE CARRIER
AMEND:  §133.240 AND §133.250
SUBCHAPTER D:  DISPUTE OF MEDICAL BILLS
AMEND:  §133.305

(PDF, Word, memo)

CHAPTER 134:  BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES AND PAYMENTS
SUBCHAPTER B:  MISCELLANEOUS REIMBURSEMENT
AMEND:  §134.110
SUBCHAPTER F:  PHARMACEUTICAL BENEFITS
AMEND:  §134.502
SUBCHAPTER G:  PROSPECTIVE AND CONCURRENT REVIEW OF HEALTH CARE
AMEND:  §134.600

(PDF, Word, memo)


The following rule was adopted on December 16, 2013.  The rule will publish in the December 27, 2013 issue of the Texas Register. The adopted amendment is effective for medical bills submitted on or after April 1, 2014.

CHAPTER 133:  GENERAL MEDICAL PROVISIONS
SUPCHAPTER B: HEALTH CARE PROVIDER BILLING PROCEDURES
ADOPT:  §133.10

(PDF, Word, memo


The following rule was adopted on December 16, 2013.  The rule will publish in the December 27, 2013 issue of the Texas Register. The adopted amendment is effective for medical bills submitted on or after April 1, 2014.

CHAPTER 41:  PRACTICE AND PROCEDURE

SUBCHAPTER A:  COMMUNICATIONS
REPEAL:  §41.50

SUBCHAPTER B:  ACCESS TO BOARD RECORDS
REPEAL:  SUBCHAPTER (ALL SECTIONS)

(PDF, Word, memo)


The following rule was adopted on November 21, 2013.  The rule will publish in the December 6, 2013 issue of the Texas Register. This rule is effective 20 days after being filed with the Texas Register.

CHAPTER 89:  CRIME VICTIMS COMPENSATION ACT
REPEAL:  Chapter 89

 (PDF, Word, memo)


The following rule was adopted on November 21, 2013.  The rule will publish in the December 6, 2013 issue of the Texas Register.  This rule is effective September 1, 2014.

CHAPTER 103:  AGENCY ADMINISTRATION
REPEAL:  Chapter 103, Subchapter A 103.1-103.3 and 103.100, Subchapter B 103.101, Subchapter C 103.300-103.322, and Subchapter D 103.400

(PDF, Word, memo)


The following rule was adopted on November 21, 2013.  The rule will publish in the December 6, 2013 issue of the Texas Register.  This rule is effective 20 days after being filed with the Texas Register.

CHAPTER 102:  PRACTICE AND PROCEDURES – GENERAL PROVISIONS
AMEND:  102.8

(PDF, Word, memo)


The following rule was adopted on November 12, 2013.  The rule will publish in the November 29, 2013 issue of the Texas Register.  This rule is effective December 8, 2013.

CHAPTER 43:  INSURANCE COVERAGE
REPEAL:  43.15 AND 43.20

(PDF, Word, memo)


The following rule was adopted on August 5, 2013.  The rule will publish in the August 16, 2013 issue of the Texas Register. 

CHAPTER 130: IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS
AMEND: 130.1

(PDF, Word, memo)


The following rule was adopted on March 11, 2013.  The rule will publish in the March 22, 2013 issue of the Texas Register.  This rule is effective October 1, 2013.

CHAPTER 166:  ACCIDENT PREVENTION SERVICES
AMEND: 166.1, 166.3, and 166.5
NEW: 166.2
(PDF, Word, memo)

CHAPTER 166:  ACCIDENT PREVENTION SERVICES
REPEAL: 166.2, 166.4, and 166.6-166.9

(PDF, Word, memo)


The following rule was adopted on January 28, 2013.  The rule will publish in the February 8, 2013 issue of the Texas Register.  This rule is effective February 17, 2013.

Chapter 134.- Benefits – Guidelines for Medical Services, Charges, and Payments
Subchapter I – Medical Bill Reporting
Amended: 28 Tac 134.803 And 134.807
(PDF, Word, memo, Texas EDI Medical Difference Table Version 2.0 [Excel])


The following rule was adopted on December 17, 2012.  The rule was published in the December 28, 2012 issue of the Texas Register (37 TexReg 10215) .  This rule is effective January 6, 2013.

Chapter 126. General Provisions Applicable To All Benefits
New: 28 Tac 126.17
(PDF, Word, memo)


The following rules were adopted on October 17, 2012.  The rules were published in the November 2, 2012 issue of the Texas Register (37 TexReg 8839). These rules become effective January 1, 2013. 

Chapter 180. Monitoring and Enforcement
Subchapter C. Medical Quality Review Panel
New:  28 TAC 180.60, 180.62, 180.64, 180.66, 180.68, 180.70, 180.72, 180.74, 180.76, 180.78
(PDF, Word, memo)


   The following rules were adopted on July 13, 2012.  The rules were published in the July 27, 2012 issue of the Texas Register (37 TexReg 5577).  Section 110.7 and 110.103 are effective August 2, 2012 and 28 TAC 110.1, 110.101, and 110.105 are effective January 1, 2013.

Chapter 110 - Required Notices of Coverage
Subchapter A - Carrier Notices
Amended:  110.1, New:  110.7
Subchapter B - Employer Notices
Amended:  110.101, New:  110.103 And 110.105
(Word, PDF, memo)
 
The following rules were adopted on July 13, 2012.  The rules were published in the July 27, 2012 issue of the Texas Register (37 TexReg 5592).  These rules become effective January 1, 2013.

Chapter 160 – Reports of Injury and Occupational Disease--General Provisions
Amend:  160.2 And 160.3, New:  160.1
(Word, PDF, memo)


   The following rules were adopted on July 9, 2012.  The rules were published in the July 20, 2012 issue of the Texas Register (37 TexReg 5422).  These rules become effective September 1, 2012.

Chapter 127:  Designated Doctor Procedures and Requirements
Subchapter A:  Designated Doctor Scheduling and Examinations
Amend:  127.1, 127.5, 127.10, 127.20, And 127.25
Subchapter B:  Designated Doctor Certification, Recertification, and Qualifications
New:  127.100, 127.110, 127.120, 127.130, And 127.140
Subchapter C:  Designated Doctor Duties and Responsibilities
New:  127.200, 127.210, And 127.220
(Word, PDF, memo)
 
The following rule was adopted on July 9, 2012.  The rule was published in the July 20, 2012 issue of the Texas Register (37 TexReg 5476).  This rule becomes effective September 1, 2012.

Chapter 180:  Monitoring and Enforcement
Subchapter B:  Medical Benefit Regulation
Amend:  180.23
(Word, PDF, memo)
 
The following repeals were adopted on July 9, 2012. The repeal adoptions were published in the July 20, 2012 issue of the Texas Register (37 TexReg 5475 and 5476, respectively). These repeals become effective September 1, 2012.

Chapter 130:  Impairment and Supplemental Income Benefits
Subchapter A:  Impairment Income Benefits
Repeal:  130.6
(Word, PDF, memo)

Chapter 180:  Monitoring and Enforcement
Subchapter B:  Medical Benefit Regulation
Repeal:  180.21
(Word, PDF, memo


The following rules were adopted on May 11, 2012.  The rules were published in the May 25, 2012 issue of the Texas Register (37 TexReg 3833).  These rules become effective May 31, 2012.

CHAPTER 133 – GENERAL MEDICAL PROVISIONS
SUBCHAPTER D.  DISPUTE OF MEDICAL BILLS
28 TAC 133.307 and 133.308 (PDF, Word, memo)

The following rules were adopted on May 11, 2012.  The rules were published in the May 25, 2012 issue of the Texas Register (37 TexReg 3856).  These rules become effective May 31, 2012.

CHAPTER 144 – DISPUTE RESOLUTION
SUBCHAPTER A – ARBITRATION
144.1 - 144.7 and 144.9 - 144.16 (PDF, Word, memo)


The following rules were adopted on March 26, 2012.  The rules were published in the April 6, 2012 issue of the Texas Register (37 TexReg 2408).  These rules become effective July 1, 2012.

CHAPTER 133 - GENERAL MEDICAL PROVISIONS
SUBCHAPTER A - GENERAL RULES FOR MEDICAL BILLING AND PROCESSING
28 TAC 133.2
SUBCHAPTER C - MEDICAL BILL PROCESSING/AUDIT BY INSURANCE CARRIER
28 TAC 133.240, 133.250, AND 133.270
SUBCHAPTER D - DISPUTE OF MEDICAL BILLS
28 TAC 133.305
(PDFWord, memo)

The following rule was adopted on March 26, 2012.  The rule was published in the April 6, 2012 issue of the Texas Register (37 TexReg 2420).  This rule becomes effective July 1, 2012.

CHAPTER 134 - BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS
SUBCHAPTER G - PROSPECTIVE AND CONCURRENT REVIEW OF HEALTH CARE
28 TAC 134.600
(PDFWord, memo)


   The following rules were adopted on January 24, 2012 and filed with the Texas Register on January 25, 2012.  The rules were published in the February 10, 2012 issue of the Texas Register (37 TexReg 691).  The adoption is effective February 14, 2012.
 
Chapter 180 - Monitoring and Enforcement
Amended 180.1, 180.3, 180.5, 180.8, 180.27 and New 180.4, 180.9 and 180.10 (Word, PDF, memo)


   The following rules were adopted on December 12, 2011.  The rules were published in the December 23, 2011 issue of the Texas Register, (36 TexReg 8854 and 8860).   The adoption is effective January 1, 2012.
 
Chapter 126 - General Provisions Applicable to All Benefits
NEW 28 TAC 126.15 and 126.16 (Word, PDF, memo)

Chapter 128 - Benefits--Calculation of Average Weekly Wage
28 TAC 128.1 (Word, PDF, memo)

Sample Notice: Notice of Underpayment of Income Benefits (EnglishSpanishmemo)


The following rules were adopted on October 31, 2011.  The rules were published in the November 18, 2011 issue of the Texas Register (36 Tex Reg 7867).  The adoption is effective November 20, 2011.

CHAPTER 141.  DISPUTE RESOLUTION--BENEFIT REVIEW CONFERENCE
28 TAC 141.2 and 141.3 (PDF, Word, memo)


The following rule was adopted on October 31, 2011.  The rule was published in the November 18, 2011 issue of the Texas Register (36 Tex Reg 7876). The adoption is effective November 20, 2011.

CHAPTER 143.  DISPUTE RESOLUTION REVIEW BY THE APPEALS PANEL
28 TAC 143.2 (PDF, Word, memo)


The following rules were adopted on September 30, 2011.  The rules were published in the October 14, 2011 issue of the Texas Register (36 TexReg 6949). The adoption is effective October 23, 2011.

CHAPTER 134 - Benefits -- Guidelines for Medical Services, Charges, and Payments SUBCHAPTER F - Pharmaceutical Benefit

28 TAC 134.503 and 134.504 (PDF, Word, memo)


   The following rules were adopted on June 20, 2011.  The rules were published in the July 1, 2011 issue of the Texas Register (36 TexReg 4136). The adoption is effective September 1, 2011.

SUBCHAPTER I. MEDICAL BILL REPORTING
28 TAC 134.800 – 134.808 (PDF, Word, memo, Medical EDI Implementation Guidance for use on/after 9/1/11)


   The following rules were adopted on February 3, 2011.  The rule were published in the February 18, 2011 issue of the Texas Register (36 TexReg 929).   The adoption is effective August 1, 2011.

Chapter 133 -- Medical Bill Processing

28 TAC 133.10, 133.500, 133.501 and 133.502  (PDF, Word, memo


   The following rules were adopted on January 14, 2011.  The rules were published in the January 28, 2011 issue of the Texas Register (36 Tex Reg 427).  The adoption is effective January February 3, 2011.

Chapter 136 - Benefits--Vocational Rehabilitation
28 TAC 136.1 and 136.2 (PDF, Word, memo


    The following rules were adopted on December 20, 2010.  They were published in the December 31, 2010 issue of the Texas Register (35 TexReg 11188).   The adoption is effective January 9, 2011.

SUBCHAPTER A.  GENERAL RULES FOR ENFORCEMENT
28 TAC 180.1-180.3, and 180.8
SUBCHAPTER B.  MEDICAL BENEFIT REGULATION
28 TAC 180.22, 180.24-180.28, and 180.50

(PDF Format, Word Format, memo)

SUBCHAPTER A.  GENERAL RULES FOR ENFORCEMENT
28 TAC 180.6, 180.7 and 180.10-180.18 (Repeal)
SUBCHAPTER B.  MEDICAL BENEFIT REGULATION
28 TAC 180.20 and 180.26 (Repeal)

(PDF Format, Word Format, memo)


   The following rule was adopted on an emergency basis on December 17, 2010. The adoption is effective January 1, 2011 - June 29, 2011.

SUBCHAPTER F  PHARMACEUTICAL BENEFITS
28 TAC 134.503 Pharmacy Fee Guideline (PDF format, Word format, memo, extension memo)


    The following rule was adopted on December 6, 2010.  The rule published in the December 17, 2010 issue of the Texas Register (35 TexReg 11378).   The adoption is effective September 1, 2011.

SUBCHAPTER A. GENERAL PROVISIONS
28 TAC 137.5 Case Manager Certification (PDF format, Word format, memo)


    The following rules were adopted on December 6, 2010.  They were published in the December 17, 2010 issue of the Texas Register (35 TexReg 11324).   The adoption is effective February 1, 2011.

SUBCHAPTER A: BENEFITS – GENERAL PROVISIONS APPLICABLE TO ALL
28 TAC 126.7 (Repeal PDF format, Word format, memo)

CHAPTER 127 – Designated Doctor Procedures and Requirements
SUBCHAPTER A – Designated Doctor Scheduling and Examinations
28 TAC New 127.1, 127.5, 127.15, 127.20, and 127.25 (PDF format, Word format, memo)


   The following rules were adopted on December 3, 2010.  They were published in the December 17, 2010 issue of the Texas Register (35 TexReg 11344).  The adoption is effective January 17, 2011 (effective date correction notice).

SUBCHAPTER F - PHARMACEUTICAL BENEFITS
28 TAC 134.500, 134.506, 134.510, 134.520, 134.530, 134.540, and 134.550 (PDF format, Word format, memo, correction of effective date)


The following rule was adopted on December 3, 2010.  It was published in the December 17, 2010 issue of the Texas Register (35 TexReg 11340).  The adoption is effective September 1, 2011.

SUBCHAPTER D – DISPUTE OF MEDICAL BILLS
 28 TAC 133.306  (PDF format, Word formatmemo)


The following rules were adopted August 6, 2010.  They were published in the August 20, 2010 issue of the Texas Register (35 TexReg 7430).  The adoption is effective October 1, 2010.
Chapter 141 Dispute Resolution--Benefit Review Conference
28 TAC 141.1, 141.2, 141.4, and 141.7 (Word, PDF)


   The following rules were adopted on April 1, 2010. They were published in the Texas Register on April 16, 2010. The adoption becomes effective on April 25, 2010.
Chapter 137.  Disability Management
Subchapter B.  Return to Work
Sections 137.41 - 137.49, 137.50, and 137.51 (Word, PDF)


   The following rules were adopted February 26, 2010.  They were published in the Texas Register on March 12, 2010.  The adoption became effective on March 22, 2010.

Chapter 122.  Compensation Procedure – Claimants Benefits -- Guidelines for Section 122.100.  Claim for Death Benefits (Word, PDF)

Chapter 132. Death Benefits – Death and Burial Benefits
Section 132.6.  Eligibility of Other Surviving Dependents and Eligible Parents to Receive Death Benefits
Section 132.11.  Distribution of Death Benefits (Word, PDF)


   The following rules were adopted on February 26, 2010. They were published in the Texas Register on March 12, 2010. The adoption became effective on March 22, 2010.

Chapter 120 Compensation Procedure—Employers
Section 120.2 (Word, PDF)


   The following rules were adopted 12/18/09.  They were published in the Texas Register on January 1, 2010.  The adoption became effective on January 7, 2010.

Chapter 116 General Provisions--Subsequent Injury Fund
Sections 116.11 and 116.12 (Word, PDF)


   The following rules were adopted November 19, 2009.  They were published in the December 4, 2009 issue of the Texas Register (34 TexReg 8739).  The adoption is effective December 13, 2009.

Chapter 143 Dispute Resolution Review by the Appeals Panel
Sections 143.2 - 143.5 (Word, PDF)


   The following rules were adopted October 1, 2009.  They were published in the Texas Register on October 23, 2009.  The adoption becomes effective on October 29, 2009. 

Chapter 164 Hazardous Employer Program
Sections 164.1 - 164.12 and 164.14 - 164.18 (Repeal Word, PDF)
Chapter 169
Sections 169.1 and 169.2 (Repeal Word, PDF)


   The following rule was adopted March 11, 2009.  It was published in the Texas Register on March 27, 2009.  The adoption becomes effective on July 1, 2009.

Chapter 130 – Impairment and Supplemental Income Benefits
Subchapter B. Supplemental Income Benefits
Sections 130.101 – 130.109 (Word, PDF)


The following rule was adopted January 9, 2009.  It was published in the Texas Register on January 23, 2009.  The adoption becomes effective on January 29, 2009.
 
Chapter 133.  General Medical Provisions
Subchapter B.  Health Care Provider Billing Procedures
Section 133.20  Medical Bill Submission by Health Care Provider (Word, PDF)


The following rules were adopted September 22, 2008.  They were published in the Texas Register on October 3, 2008.  The adoption becomes effective October 12, 2008.

Chapter 122.  Compensation Procedure – Claimants Benefits -- Guidelines for Section 122.100.  Claim for Death Benefits (Word, PDF)

Chapter 132.  Death Benefits – Death and Burial Benefits
Section 132.6.  Eligibility of Other Surviving Dependents and Eligible Parents to Receive Death Benefits
Section 132.9.  Duration of Death Benefits for an Eligible Grandchild, Eligible Dependent, and Eligible Parent
Section 132.11.  Distribution of Death Benefits (Word, PDF)


The following rule was adopted on August 29, 2008.  It was published in the Texas Register September 19, 2008.  The adoption becomes effective September 23, 2008.
 
Chapter 140.  Dispute Resolution -- General Provisions
Subchapter A.  Dispute Resolution — General Provisions
Sections 140.6, 140.7 and 140.8 (NEW - Word, PDF


   The following rule was adopted August 8, 2008.  It was published in the Texas Register on August 22, 2008.  The adoption becomes effective August 31, 2008.

Chapter 134  Benefits - Guidelines for Medical Services, Charges and Payments
Subchapter E.  Health Facility Fees
Section 134.402 - Ambulatory Surgical Center Fee Guideline (Word, PDF)


The following rule was adopted July 7, 2008.  It was published in the Texas Register on July 18, 2008.  The adoption becomes effective July 27, 2008.

SUBCHAPTER A.  General Rules for Medical Billing and Processing
Sections 133.2, 133.4, and 133.5 (Word, PDF)


The following rule was adopted June 19, 2008.  It was published in the Texas Register on July 4, 2008.  The adoption becomes effective July 13, 2008.

Chapter 134.  Benefits — Guidelines for Medical Services, Charges, and Payments
Subchapter E.  Health Facility Fees
Section 134.401 - Acute Care Inpatient Hospital Fee Guideline. (REPEAL - Word, PDF)


The following rule was adopted May 5, 2008.  It was published in the Texas Register on May 16, 2008.  The adoption becomes effective May 25, 2008.

Chapter 133 - General Medical Provisions
Subchapter D. Dispute of Medical Bills
Sections 133.305, 133.307 and 133.308 (Word, PDF)


The following rule was adopted April 11, 2008.  It was published in the Texas Register on April 25, 2008.  The adoption becomes effective May 1, 2008, 20 days from the date of filing.

Chapter 133 - General Medical Provisions
Subchapter B.  Health Care Provider Billing Procedures
Section 133.10  Required Billing Forms/Formats (Word, PDF)


The following rule was adopted March 17, 2008.  It was published in the Texas Register on March 28, 2008.  The rule will become effective April 6, 2008.

Chapter 141.  Dispute Resolution - Benefit Review Conference
Section 141.6.  Requesting Interlocutory Orders. (REPEAL - Word, PDF)


The following rule was adopted January 18, 2008.  It was published in the Texas Register on February 1, 2008.  The rule will become effective February 7, 2008.

Chapter 137.  Disability Management
Subchapter B.  Return To Work
Section 137.41 (amended) and Section 137.49 (new) (Word, PDF)


The following rule was adopted on December 28, 2007 and will publish in the Texas Register on January 11, 2008.  The rule will become effective March 1, 2008.

Chapter 134  Benefits - Guidelines for Medical Services, Charges and Payments
SUBCHAPTER A.  Medical Reimbursement Policies
Adopted Amendment - Section 134.1
Adopted New - Section 134.2

SUBCHAPTER C.  Medical fee Guidelines
Adopted New - Sections 134.203 and 134.204 (Word, PDF) [rule text begins on page 141]


The following rule was adopted on December 21, 2007  and will publish in the Texas Register on January 11, 2008.  The rule will become effective January 16, 2008.

Chapter 180 - Monitoring and Enforcement
Subchapter A.  General Rules for Enforcement
Section 180.19 - Performance Based Oversight Incentives ( Word, PDF)


The following rule was adopted on December 28, 2007  and will publish in the Texas Register on January 11, 2008.  The rule will become effective March 1, 2008.

Chapter 134 -Benefits - Guidelines for Medical Services, Charges, and Payments
Subchapter E.  Health Facility Fees
Section 134.403 - Hospital Facility Fee Guideline - Outpatient
Section 134.404 - Hospital Facility Fee Guideline - Inpatient  (Word, PDF) [rule text begins on page 125]


The following rules were adopted on December 19, 2007 and will publish in the Texas Register on January 4, 2008.  The rules will become effective January 9, 2008.

CHAPTER 131.  Benefits – Lifetime Income Benefits
28 TAC Section 131.1 REPEAL (html, pdf)


SUBCHAPTER G.  Prospective and Concurrent Review of Health Care
28 TAC Section 134.650 REPEAL (html, pdf


The following rule was adopted on December 10, 2007 and will publish in the Texas Register on December 21, 2007.  The rule will become effective December 30, 2007.

Chapter 134  Benefits - Guidelines for Medical Services, Charges and Payments
SUBCHAPTER E.  Health Facility Fees
Section 134.402 (html, pdf


The following rule was adopted on September 24, 2007 and will publish in the Texas Register on October 5, 2007.  The rule will become effective October 15, 2007.

Chapter 120  Compensation Procedures -- Employers
Section 120.2  Employer's First Report of Injury and Notice of injured Employee Rights and Responsibilities (html, pdf)


The following rule was adopted on September 10, 2007 and will publish in the Texas Register on September 21, 2007.  The rule will become effective September 30, 2007.

Chapter 137 - Disability Management
Subchapter D.  Treatment Planning
Section 137.300 - Required Treatment Planning (html, pdf)


The following rule was adopted on August 2, 2007 and will publish in the Texas Register on August 17, 2007.  The rule will become effective immediately.

Chapter 137. Disability Management Subchapter D. Treatment Planning (html, pdf)


The following rule was adopted on April 5, 2007 and will publish in the Texas Register on April 20, 2007.  The rule will become effective immediately.

Chapter 137. Disability Management
Subchapter D. Treatment Planning (html, pdf)


The following rules were adopted on December 29, 2006 and will publish in the Texas Register on January 12, 2007.  The rules will become effective on January 19, 2007. 

28 TAC Section 137 is effective on or after May 1, 2007.
28 TAC Section 137.100 and 28 TAC 137.300 apply to health care provided on or after May 1, 2007.

Chapter 137. DISABILITY MANAGEMENT
Subchapter A. General Provisions
Section 137.1
Subchapter B. Return to Work
Section 137.10
Subchapter C. Treatment Guidelines
Section 137.100
Subchapter D. Required Treatment Planning
Section 137.300 (html, pdf)


The following rules were adopted on December 8, 2006 and will publish in the Texas Register on December 22, 2006.  The rules will become effective on January 15, 2007.

MEDICAL DISPUTE RESOLUTION
Repeal -
Chapter 133 - Medical Billing and Processing
Subchapter D. Dispute and Audit of Bills by Insurance Carriers
Sections 133.305, 133.307 and 133.308 (html, pdf

Adopt new with changes -
Chapter 133 - Medical Billing and Processing
Subchapter D. Dispute and Audit of Bills by Insurance Carriers
Sections 133.305, 133.307 and 133.308 (the html document is divided into two parts - html part 1, html part 2, pdf)


The following rule was adopted on December 7, 2006 and will publish in the Texas Register on December 22, 2006.  The rule will become effective on December 31, 2006.

HB 251
Chapter 102 - Practices and Procedures - General Provisions
Section 102.11 Electronic Formats for Electronic Claim Data Request and Report (html, pdf)


The following rule was adopted on December 1, 2006 and will publish in the Texas Register on December 15, 2006.  The rule will become effective on December 24, 2006.

REQUIRED BILLING FORMS/FORMATS
Chapter 133 - General Medical Provisions
Subchapter B - Health Care Provider Billing Procedures
Section 133.10 Required Billing Forms/Formats (html, pdf


The following rules were adopted on August 14, 2006 and will publish in the Texas Register on September 1, 2006.  The rules will become effective on September 4, 2006.

REQUESTING INTERLOCUTORY ORDERS
CHAPTER 141 - Dispute Resolution--Benefit Review Conference
Section 141.5     Description of the Benefit Review Conference
Section 141.6     Requesting Interlocutory Orders
Section 141.7     Division Actions After a Benefit Review Conference
 


The following rules were adopted on July 27, 2006. On August 11, 2006, the adopted rules will publish in the Texas Register. 

DESIGNATED DOCTOR

CHAPTER 126 - GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS

Section 126.5 Entitlement and Procedure for Requesting Required Medical Examinations (Amendment) [The rule will become effective on January 1, 2007]

Section 126.6 Required Medical Examination (Amendment) [The rule will become effective on January 1, 2007]

Section 126.7 Suspension of Temporary Income Benefits Based On the Opinion of a Carrier-Selected Required Medical Examination Doctor (Repeal) [The repeal will become effective on December 31, 2006.]

Section 126.7 Designated Doctor Examinations: Requests and General Procedures (New) [The rule will become effective on January 1, 2007]

CHAPTER 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS
SUBCHAPTER A - Impairment Income Benefits

Section 130.2 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by the Treating Doctor (Amendment) [The rule will become effective on January 1, 2007]

Section 130.5 Impairment Income Benefits (Repeal)  [The repeal will become effective on December 31, 2006.]

Section 130.6 Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings (Amendment) [The rule will become effective on January 1, 2007]

SUBCHAPTER B - Supplemental Income Benefits

Section 130.110 Return to Work Disputes During Supplemental Income Benefits; Designated Doctor (Repeal) [The repeal will become effective on December 31, 2006.]

PEER REVIEW

CHAPTER 180 - MONITORING AND ENFORCEMENT
SUBCHAPTER B - Medical Benefit Regulation [The rules will become effective on August 16, 2006]

Section 180.21 Division Designated Doctor List (Amendment)

Section 180.22 Health Care Provider Roles and Responsibilities (Amendment)

Section 180.28 Peer Review Requirements, Reporting, and Sanctions (New)


The following rules were adopted on July 21, 2006 and will publish in the Texas Register on August 4, 2006.  The rules will become effective on August 10, 2006.

E-BILLING

Chapter 133 - MEDICAL BILLING AND PROCESSING
Subchapter G  Electronic Medical Billing, Reimbursement, and Documentation

Section 133.500  Electronic Formats for Electronic Medical Bill Processing (new)

Section 133.501  Electronic Medical Bill Processing (new)


The following rule was adopted on June 19, 2006 and will publish in the Texas Register on July 7, 2006. The rule will  become effective on July 9, 2006.

TREATING DOCTOR EXAMINATION TO DEFINE THE COMPENSABLE INJURY

Chapter  126.14 - Treating Doctor Examination to Define the Compensable Injury


      The following rules were adopted on April 11, 2006 and will published in the Texas Register on April 28, 2006. The rules will  become effective on May 2, 2006.

PREAUTHORIZATION

Chapter 134 Benefits - Guidelines for Medical Service, Charges, and Payments Subchapter G Prospective and Concurrent of Health Care
Section 134.600  Preauthorization, Concurrent Review, and Voluntary Certification of Health Care (Amended)

MEDICAL BILLING AND REIMBURSEMENT

Chapter 133 Medical Billing and Processing
Subchapter A General Rules for Required Reports
Section 133.1  Definitions for Chapter 133 - Benefits--Medical Benefits (Repeal)
Section 133.2  Sharing Medical Reports and Test Results (Repeal)
  

Subchapter B Required Reports
Section 133.100  Required Medical Reports (Repeal)
Section 133.104  Consultant Medical Reports (Repeal)
Section 133.105  Physical or Occupational Therapy Report (Repeal)
Section 133.106  Fair and Reasonable Fees for Required Reports and Records (Repeal)

Subchapter D Dispute and Audit of Bills for Insurance Carriers
Section 133.300  Insurance Carrier Receipt of Medical Bills from Health Care Providers (Repeal)
Section 133.301  Retrospective Review of Medical Bills (Repeal)
Section 133.302  Preparation for an Onsite Audit (Repeal)
Section 133.303  Onsite Audits (Repeal)
Section 133.304  Medical Payments and Denials (Repeal)

Subchapter E Compelling Production of Documents
Section 133.401  Orders for Production of Documents (Repeal)
Section 133.402  Delivery of Order; Compliance (Repeal)
Section 133.403  Noncompliance; Enforcement (Repeal)

Chapter 134 Benefits - Guidelines for Medical Services, Charges, and Payments

Subchapter A. Medical Policies
Section 134.1  Use of the Fee Guidelines (Repeal)
Section 134.5  Treating Doctor Attendance at Medical Examination Under a Medical Examination Order (Repeal)
Section 134.6  Travel Expenses Incurred by the Injured Employee (Repeal)

Subchapter I Provider Billing Procedures
Section 134.800  Required Billing Forms and Information (Repeal)
Section 134.801  Submitting Medical Bills for Payment (Repeal)
Section 134.803  Calculating Interest for Late Payment on Medical Bills and Refunds (Repeal)

Chapter 133 General Medical Provisions

Subchapter A General Rules for Medical Billing and Processing
Section 133.1  Applicability of Medical Billing and Processing  (New)
Section 133.2  Definitions (New)
Section 133.3  Communication Between Health Care Providers and Insurance Carriers (New)

Subchapter B Health Care Provider Billing Procedures (New)
Section 133.10  Required Billing Forms/Formats (New)
Section 133.20  Medical Bill Submission by Health Care Provider (New)

Subchapter C Medical Bill Processing/Audit by Insurance Carrier
Section 133.200  Insurance Carrier Receipt of Medical Bills from Health Care Providers (New)
Section 133.210  Medical Documentation (New)
Section 133.230  Insurance Carrier Audit of a Medical Bill (New)
Section 133.240  Medical Payments and Denials (New)
Section 133.250  Reconsideration for Payment of Medical Bills (New)
Section 133.260  Refunds (New)
Section 133.270  Injured Employee Reimbursement for Health Care Paid (New)
Section 133.280  Employer Reimbursement for Health Care Paid (New)

Chapter 134 Benefits - Guidelines for Medical Services, Charges, and Payments

Subchapter A Medical Reimbursement Policies
Section 134.1 Medical Reimbursement (New)

Subchapter B Miscellaneous Reimbursement
Section 134.100  Reimbursement of Treating Doctor for Attendance at Required Medical Examination (New)
Section 134.110  Reimbursement of Injured Employee for Travel Expenses Incurred (New)
Section 134.120  Reimbursement for Medical Documentation (New)
Section 134.130  Interest for Late Payment on Medical Bills and Refunds (New)

Subchapter I Medical Bill Reporting
Section 134.802 Insurance Carrier Medical Electronic Data Interchange to the Division  (Amended)


   The following rules were adopted on February 2, 2006 and published in the Texas Register on February 17, 2006. The rules will  become effective on February 22, 2006.

CHAPTER 137  DISABILITY MANAGEMENT
SUBCHAPTER B.  RETURN TO WORK 

137.41 Purpose
137.42 Definitions
137.43 Return-to-Work Account Administrator
137.44 Return-to-Work Account for Small Employers 
137.45 Employer Eligibility for Reimbursement from the Return-to-Work Account
137.46 Application for Reimbursement from the Return-to-Work Account
137.47 Criteria for Evaluation of Applications
137.48 Return-to-Work Account Administrator Determinations


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Last updated: 03/13/2014



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