Texas Department of Insurance

Workers' Compensation


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History of Rulebook Supplements

Note that the chart below is meant to serve only as a reference for the dates of past rule supplements. To view current Workers' Compensation rules, visit the Rules page on this website.

2006-06 Rules Adopted December 2006

Table of Contents Replace Entire Table of Contents
Chapter Rules Affected by Change Effective Date Instructions
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102

HB 251

CHAPTER 102 - PRACTICES AND PROCEDURES - GENERAL PROVISIONS

§102.11  Electronic Formats for Electronic Claim Data Request and Report (New)

 12/31/06 - New Entire old chapter Entire new chapter

133

Medical Dispute Resolution

CHAPTER 133 - MEDICAL BILLING AND PROCESSING

SUBCHAPTER D - Dispute and Audit of Bills by Insurance Carriers

 §133.305 - Medical Dispute Resolution - General (Repeal)

§133.307 - Medical Dispute Resolution of a Medical Fee Dispute (Repeal)

§133.308 - Medical Dispute Resolution by Independent Review Organizations (Repeal)

 12/31/06 - Repeal Entire Old Chapter  

133 (same
document
as above)

Medical Dispute Resolution (continued) 

§133.305 - MDR - General (New)

§133.307 - MDR of Fee Disputes (New)

§133.308 - MDR by Independent Review Organizations (New)

 12/31/06 - New   Entire New Chapter

130

Designated Doctor

CHAPTER 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS

SUBCHAPTER A - Impairment Income Benefits

§130.6  Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings

 01/01/07 -
Correction of Error		 Pages 9 - 14 Pages 9 - 14

 2006-05 Rules Adopted July and August 2006

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126

 

Designated Doctor

CHAPTER 126 - GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS
§126.5  Entitlement and Procedure for Requesting Required Medical Examinations (Amendment)
§126.6 Required Medical Examination (Amendment)
§126.7 Suspension of Temporary Income Benefits Based On the Opinion of a Carrier-Selected Required Medical Examination Doctor (Repeal)
§126.7 Designated Doctor Examinations: Requests and General Procedures (New)

12/31/06 - Repeal

01/01/07 - New & Amendments

 Entire old chapter Entire new chapter

130

Designated Doctor

CHAPTER 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS

SUBCHAPTER A - Impairment Income Benefits
§130.2 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by the Treating Doctor (Amendment)
§130.5 Impairment Income Benefits (Repeal)
§130.6 Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings (Amendment)

12/31/06 - Repeal

01/01/07 - Amendments

 Entire old chapter Entire new chapter

130 (same document as above)

Designated Doctor

CHAPTER 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS

SUBCHAPTER B - Supplemental Income Benefits
§130.110  Return to Work Disputes During Supplemental Income Benefits; Designated Doctor (Repeal)

 12/31/06 - Repeal Entire old chapter Entire new chapter

141

Requesting Interlocutory Orders

CHAPTER 141.  DISPUTE RESOLUTION - BENEFIT REVIEW CONFERENCE
§141.5  Description of the Benefit Review Conference
§141.6  Requesting Interlocutory Orders
§141.7  Division Actions After a Benefit Review Conference

9/4/06 - Amendments Entire old chapter Entire new chapter

180

Peer Review

CHAPTER 180 - MONITORING AND ENFORCEMENT
SUBCHAPTER B - Medical Benefit Regulation
§180.21 Division Designated Doctor List (Amendment)
§180.22  Health Care Provider Roles and Responsibilities (Amendment)
§180.28  Peer Review Requirements, Reporting, and Sanctions (New)

 08/16/06 - New & Amendments Entire old chapter Entire new chapter

 

2006-04 Rules adopted July 2006

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133

ELECTRONIC MEDICAL BILLING

Chapter 133 - General Medical Provisions

§133.500 Electronic Formats for Electronic Medical Bill Processing

§133.501 Electronic Medical Bill Processing

 August 10, 2006 Entire old chapter Entire new chapter

 2006-03 Rules adopted June 2006

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126

TREATING DOCTOR

Chapter 126 -  General Provisions Applicable to All Benefits

§126.14 Treating Doctor Examination to Define Compensable Injury (new)

 July 9, 2006 Entire old chapter Entire new chapter

 2006-02 Rules adopted April 2006

133

MEDICAL BILLING

Chapter 133 Medical Billing and Processing

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

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

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

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

Chapter 133 General Medical Provisions

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

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

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

 May 2, 2006 Entire old chapter Entire new chapter

134

MEDICAL BILLING

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

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

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

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

Subchapter A Medical Reimbursement Policies
§134.1 Medical Reimbursement (New)Subchapter B Miscellaneous Reimbursement
§134.100  Reimbursement of Treating Doctor for Attendance at Required Medical Examination (New)
§134.110  Reimbursement of Injured Employee for Travel Expenses Incurred (New)
§134.120  Reimbursement for Medical Documentation (New)
§134.130  Interest for Late Payment on Medical Bills and Refunds (New)
Subchapter I Medical Bill Reporting
§134.802 Insurance Carrier Medical Electronic Data Interchange to the Division  (Amended)

PREAUTHORIZATION

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

Subchapter G Prospective and Concurrent of Health Care
§134.600  Preauthorization, Concurrent Review, and Voluntary Certification of Health Care (Amended)

 May 2, 2006 Entire old chapter Entire new chapter

2006-01 Rules adopted February 2006

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137

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

 February 22, 2006 NA Entire new chapter

 

Supplements from 2005 

2005-04 Emergency Rules

These emergency rules were adopted by the Commissioner of Workers? Compensation and filed with the Texas Register on November 3, 2005. These rules expire on March 2, 2006 with the option to extend once for 60 days. It is recommended that the emergency rules be maintained in addition to prior versions of these rules should they be required for future use.

Chapter

Rules Affected by Change

Medical Billing Timeframes §133.301. Retrospective Review of Medical Bills (Amended)
§133.302. Preparation for an Onsite Audit (Amended)
§133.304. Medical Payments and Denials (Amended)
§134.801. Submitting Medical Bills for Payment (Amended)
Preauthorization § 134.600. Preauthorization, Concurrent Review, and Voluntary Certification of Health Care (Amended)

 

2005-03 Rules adopted at the May 2005 public meeting

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112 § 112.102, 112.200, 112.402
Scope of Liability for Compensation		 June 9, 2005 Entire current chapter Entire new chapter
133 § 133.401 Orders for Production of Documents
§ 133.403 Noncompliance; Enforcement		 June 9, 2005 Entire current chapter Entire new chapter
134 § 134.303 (NEW) 2005 Dental Fee Guideline June 9, 2005 Entire current chapter Entire new chapter
140 § 140.1 Definitions
§ 140.4 Conduct and Decorum		 June 9, 2005 Entire current chapter Entire new chapter
145 § 145.1-145.28 (REPEAL) - Dispute Resolution-Hearings Under the Administrative Procedure Act June 9, 2005 Entire current chapter No replacement
148 § 148.1-148.23 (NEW) - Hearings Conducted by SOAH June 9, 2005 Entire current chapter Entire new chapter
149 § 149.1-149.10 (NEW)- Memorandum of Understanding With SOAH June 9, 2005 Entire current chapter Entire new chapter
166 166.4 Accident Prevention Services
166.6 Exchange of Information for the Inspection		 June 9, 2005 Entire current chapter Entire new chapter

 

2005-02 Rules adopted at the April 2005 public meeting

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102 §102.3. Computation of Time. (amendment)
§102.4. General Rules for Non-Commission Communications. (amendment)
§102.5. General Rules for Written Communications To and From the Commission. (amendment)		 May 1, 2005 Entire current chapter Entire new chapter
134 §134.800. Required Billing Forms and Information. (amendment)
§134.802. Insurance Carrier Medical Electronic Data Interchange to the Commission. (amendment)		 May 1, 2005 Entire current chapter Entire new chapter


2005-01 Rules adopted at the February 2005 public meeting

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108 §108.1. Charges for Copies of Public Information. (amendment) March 10, 2005 Entire current chapter Entire new chapter
134 §134.402. Ambulatory Surgical Center Fee Guideline. (amendment) March 10, 2005 Entire current chapter Entire new chapter

Supplements from 2004

2004-04 Rules adopted at the August 19, 2004 public meeting

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122

§122.2. Injured Employee's Claim for Compensation. (amendment)

§122.100. Claim for Death Benefits (amendment)

 September 12, 2004 Entire current chapter Entire new chapter
133

§133.308. Medical Dispute Resolution by Independent Review Organizations (amendment)

§133.309. Alternate Medical Necessity Dispute Resolution by Case Review Doctor (new)

 September 12, 2004 Entire current chapter Entire new chapter
134 §134.650. Prospective Review of Medical Care Not Requiring Preauthorization (PRM process) (new) September 12, 2004 Entire current chapter Entire new chapter
165

§165.1. Identification and Notification of Certain Policyholders Insured by the Texas Mutual Insurance Company Acting as the Insurer of Last Resort. (amendment)

§165.2. Safety Consultation. (amendment)

§165.3. Formulation and Components of Accident Prevention Plan. (amendment)

§165.7. Report of Follow-Up Inspection. (amendment)

 September 12, 2004 Entire current chapter Entire new chapter
180

§180.20. Commission Approved Doctor List. (amendment)

§180.21. Commission Designated Doctor List. (amendment)

§180.27. Sanctions Process/Appeals/ Restoration/Reinstatement. (amendment)

 September 12, 2004 Entire current chapter Entire new chapter

 

 2004-03 Rules adopted at the June 2004 public meeting 

Chapter

Rules Affected by Change

Effective Date

Instructions

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134

§134.800 Required Billing Forms and Information (amendment)

§134.802 Insurance Carrier's Submission of Medical Bills to the Commission (amendment)

 July 11, 2004 Entire current chapter Entire new chapter

 

2004-02 Rules adopted at the April 2004 public meeting

Chapter

Rules Affected by Change

Effective Date

Instructions

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114

§114.1 Purpose (amendment)

§114.2 Definitions. (amendment)

§114.3. Application Form and Financial Information Requirements. (amendment)

§114.4. Security Deposit Requirements. (amendment)

§114.5. Excess Insurance Requirements. (amendment)

§114.6. Safety Program Requirements. (amendment)

§114.7. Certification Process. (amendment)

§114.9. Required Safety Program Inspections. (amendment)

§114.10. Claims Contractor Requirements. (amendment)

§114.11. Audit Program. (amendment)

§114.12. Required Reporting. (amendment)

§114.14. Impaired Employer. (amendment)

§114.15. Revocation or Suspension of Certificate of Authority To Self-Insure. (amendment)

 May 9, 2004 Entire current chapter Entire new chapter
134 §134.402 Ambulatory Surgical Center Fee Guideline. (new) - applicable to facility services provided by an ASC on or after 9/1/04 May 9, 2004 Entire current chapter Entire new chapter
143

§143.1 Definitions (amendment)

§143.3. Requesting the Appeals Panel to Review the Decision of the Hearing Officer. (amendment)

§143.4. Responding to a Request for Review by the Appeals Panel. (amendment)

§143.5. Decision of the Appeals Panel. (amendment)

 May 9, 2004 Entire current chapter Entire new chapter

 

2004-01 - Rules adopted at the February 19, 2004 public meeting

Chapter

Rules Affected by Change

Effective Date

Instructions

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124

§124.1 Notice of Injury. (amendment)

§124.3 Investigation of an Injury and Notice of Denial/Dispute. (amendment)

 March 14, 2004 Entire current chapter Entire new chapter
130

§130.1. Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment.. (amendment)

§130.5. Entitlement and Procedure for Requesting Designated Doctor Examinations related to Maximum Medical Improvement and Impairment Rating. (amendment)

§130.6. Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings. (amendment)

§130.12. Finality of the First Certification of Maximum Medical Improvement and/or First Assignment of Impairment Rating. (new)

§130.110. Return to Work Disputes During Supplemental Income Benefits; Designated Doctor. (amendment)

 March 14, 2004 Entire current chapter Entire new chapter
132 §132.17 Denial, Dispute and Payment of Death Benefits. (amendment) March 14, 2004 Entire current chapter Entire new chapter
134

§134.503. Reimbursement Methodology. (amendment)

§134.504. Pharmaceutical Expenses Incurred by the Injured Employee. (amendment)

§134.600. Preauthorization, Concurrent Review, and Voluntary Certification of Health Care. (amendment)

March 14, 2004

 

 

 

Entire current chapter

 

 

Entire new chapter

 

 

 

Supplements from 2003

2003-02 - Rules adopted at the August 2003 public meetings

Chapter

Rules Affected by Change

Effective Date

Instructions

180 §180.1. Definitions (amendment)
§180.3. Compliance Audits (amendment)
§180.4. Review of Employer Compliance (repeal)
§180.6. Evidence of Patterns of Practice (amendment)
§180.8. Notices of Violation, Warning Letters, and Notices of Intent (amendment)
§180.10. Duration and Extent of Noncompliance (new)
§180.11. Compliance Categories (new)§180.12. Compliance Standards and Compliance Rates (new)
§180.13. Warning Letter Criteria; Relevant Time Period (new)
§180.14. General Provisions for Penalty Calculations (new)
§180.15. Base Penalties (new)
§180.16. Review Modifiers (new)
§180.17. Audit Modifiers (new)
§180.18. Applicability (new)		 Sept. 14, 2003 Replace entire Chapter 180

 

2003-01 - Rules adopted at the May 2003 public meetings

Chapter

Rules Affected by Change

Effective Date

Instructions

110 §110.1 - Requirements for Notifying the Commission of Insurance Coverage (amendment) June 5, 2003 Replace entire Chapter 110
124 §124.2 - Carrier Reporting and Notification Requirements(amendment)
§124.7 - Initial Payment of Temporary Income Benefits (amendment)		 June 5, 2003 Replace entire Chapter 124
126 §126.11 - Extension of the Date of Maximum Medical Improvement for Spinal Surgery (amendment) June 5, 2003 Replace entire Chapter 126
133 §133.2 - Sharing Medical Reports and Test Results (amendment)
§133.206 - Spinal Surgery Second Opinion Process (repeal)		 June 5, 2003 Replace entire Chapter 133
165 §165.6 - Follow-up Inspection of the Policyholder's Premises by the Division (amendment) June 5, 2003 Replace entire Chapter 165
180 §180.20 - Commission Approved Doctor List (amendment)
§180.21 - Commission Designated Doctor List(amendment)
§180.23 - Commission Required Training for Doctors/Certificate of Registration Levels (amendment)		 June 5, 2003 Replace entire Chapter 180

 

Supplements from 2002

2002-06 - Rules adopted at the December 2002 public meetings

Chapter Rule Effective Date
133 133 General Medical Provisions January 1, 2003
134 134 Benefits Guidelines for Medical Services, Charges, and Payments January 1, 2003


 

2002-05 - Rules adopted at the October 2002 public meetings

Chapter Rule Effective Date
134
134.501 Initial Pharmaceutical Coverage (New)
 November 7, 2002


 

2002-04 - Rules adopted at the September 2002 public meetings

Chapter Rule Effective Date
109
109.1 Workers' Compensation Coverage for State Employees
 October 9, 2002
164
164.9 Hazardous Employer Program
 October 9, 2002


 

2002-03 - Rules adopted at the July 2002 public meetings

Chapter Rule Effective Date
116
116.11 Request for Reimbursement or Refund from the Subsequent Injury Fund (amended)
116.12 Subsequent Injury Fund Payment / Reimburesement Schedule (amended)
 August 15, 2002
134
134.1000 Mental Health Treatment Guideline (repeal)
134.1001 Spine Treatment Guideline (repeal)
134.1002 Lower Extremities Treatment Guideline (repeal)
134.1003 Upper Extremities Treatment Guideline (repeal)
 August 15, 2002


 

2002-02 - Rules adopted at the April 2002 public meeting

Chapter Rule Effective Date
120
120.4 Employers' Wage Statement (new)
 May 16, 2002
122
122.5 Employee's Multiple Employment Wage Statement (new)
 May 16, 2002
128
128.1 Average Weekly Wage: General Provisions (amended)
128.2 Carrier's Presumption of Employee's Average Weekly Wage (amended)
128.7 Average Weekly Wage for School District Employees (new)
 May 16, 2002
134
134.1 Use of the Fee Guidelines (amended)
134.202 Medical Fee Guideline (new)
 May 16, 2002

 

2002-01 - Rules adopted at the February 2002 public meetings

Chapter Rule Effective Date
126
126.8 Commission Approved Doctor List (amendment)
126.10 Commission Approved List of Designated Doctors (repeal)
 March 14, 2002
133
133.3 Responsibilities of Treating Doctor (repeal)
133.4 Consulting and Referral Doctors (repeal)
 March 14, 2002
134
134.100 Provider Disclosure of Financial Interest, Submission to the Commission (repeal)
134.101 Provider Disclosure of Financial Interest, Submission to the Carrier (repeal)
 March 14, 2002
180
180.1 Definitions (amendment)
180.2 Referrals (new)
180.7 Date Violation Deemed to Have Occurred; Establishing Willful Violations (amendment)
180.20 Commission Approved Doctor List (new)
180.21 Commission Designated Doctor List (new)
180.22 Health Care Provider Roles and Responsibilities (new)
180.23 Commission Required Training for Doctors Certification Levels (new)
180.24 Financial Disclosure (new)
180.25 Improper Inducements, Influence, and Threats (new)
180.26 Doctor and Insurance Carrier Sanctions (new)
180.27 Sanctions Process/ Appeals/Restoration/ Reinstatement (new)
 March 14, 2002

 

Supplements for 2001

2001-01 - Rules adopted at the November and December 2001 public meetings

Chapter Rule Effective Date
126
126.5 Entitlement and Procedure for Requesting Required Medical Examinations (amended)
126.6 Order for Required Medical Examination (amended)
126.7 Suspension of Temporary Income Benefits Based on the Opinion of a Carrier Selected Required Medical Examination Doctor (amended)
 January 2, 2002
130
130.1 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment (amended)
130.2 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by the Treating Doctor (amended)
130.3 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by a Doctor other than the Treating Doctor (amended)
130.4 Presumption that Maximum Medical Improvement (MMI) has been Reached and Resolution when MMI has not been Certified (amended)
130.5 Entitlement and Procedure for Requesting Designated doctor Examinations Related to Maximum Medical Improvement and Impairment Rating (new)
130.6 Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings (amended)
130.110 Return to Work Disputes During Supplemental Income Benefits; Designated Doctor (amended)
 January 2, 2002
131
131.1 Initiation of Lifetime Income Benefits (amended)
 January 3, 2002
133
133.206 Spinal Surgery Second Opinion Process (amended)
 January 1, 2002
133.305 Medical Dispute Resolution - General (new)
133.307 Medical Dispute Resolution of Regarding a Medical Fee Dispute (new)
133.308 Medical Dispute Resolution By Independent Review Organizations (new)
 January 2, 2002
134
134.500 Definitions (new)
134.502 Pharmaceutical Services (new)
134.503 Reimbursement Methodology (new)
134.504 Pharmaceutical Expenses Incurred by the Injured Employee (new)
134.506 Outpatient Drug Formulary (new)
 January 3, 2002
134.600 Preauthorization, Concurrent Review and Voluntary Certification of Health Care (amended)
 January 1, 2002
166
166.2 Initial Writing and Resumption of Writing of Workers' Compensation Insurance (amended)
 December 9, 2001

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Last updated: 08/31/2010



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