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Workers´ Compensation Networks Informal Working Group (December 14, 2005)

December 14, 2005
10:30 a.m. to Noon
Hobby Building - Room 102

Agenda - December 14, 2005

Agenda Item Presenter
  • Antitrust statement
  • Review of ground rules
Audrey Selden
Provider Ombudsman
Senior Associate Commissioner
Consumer Protection

Margaret Lazaretti
Deputy Commissioner
HMO Division
  • Introductions
  • Review purpose and agenda
  • Updates regarding workers´ compensation
    networks rule, training and education plans,
    and demonstration of web resource materials
  • Discuss future meeting topics
  • Set 2006 meeting schedule

Meeting Notes - December 14, 2005

Audrey Selden welcomed the group, and reviewed the ground rules and the antitrust statement. Audrey explained that the purpose of the Workers´ Compensation Networks Informal Working Group (IWG) is to be a forum for input and counsel to TDI as workers´ compensation networks (WC networks) are implemented. The implementation of WC networks in Texas will be improved by all participants being open and inviting of comments. Audrey asked the members to suggest names of additional organizations that should be represented. The Texas Osteopathic Medical Association, the Texas Self-Insurance Association, and HealthSouth were suggested, and subsequently they agreed to participate. The roster, meeting notes, and other information will be posted on a new IWG web page on TDI´s website at this link http://www.tdi.state.tx.us/consumer/wcnetiwg.html. FYI Norman Darwin, the Injured Employee Public Counsel, is a member of the IWG. Mr. Darwin, as well as representatives of Liberty Mutual and PCI, were unable to attend the December meeting and will attend the February meeting.

Margaret Lazaretti gave an overview of where we are on implementation of the WC networks. First, important resources, links, FAQS, and the latest news will be posted on the WCNET web page at http://www.tdi.state.tx.us/wc/wcnet/index.html. On January 2, 2006, TDI will begin accepting applications. There is a 60-day application review period after the application is determined to be complete. TDI expects to have certified WC networks by March 2006, possibly sooner. Several types of training are occurring now, including general training for staff who answer calls and staff who will be reviewing the WC network applications, training for TDI and Division of Workers´ Compensation (DWC) staff about the new WC networks, and training for groups who wish to submit applications and other outside groups. Margaret explained that the workshop video/audio is available for viewing via http://www.house.state.tx.us/media/additional/79.htm. The accompanying PowerPoint slides are available on the WCNET page at http://www.tdi.state.tx.us/wc/wcnet/index.html. Please send requests for presentations to the special WCNET e-mail address WCNET@tdi.texas.gov.

Audrey added that TDI is also preparing informational materials for injured workers about WC networks. A flier is being pilot-tested in DWC field offices and also via a focus group of injured workers on 12/16/2005. Materials will be written in plain language and at a fifth-grade reading level, and translated into Spanish, Chinese, Korean, and Vietnamese. Audrey explained that TDI´s goals are to do an excellent job, beat deadlines, and implement WC networks in such a manner that the Texas WC networks become the model. The more input TDI receives early on in the process, the better the product will be. Members are urged to speak freely about potential problems and pitfalls they may identify so that TDI can make course corrections early.

A summary of the group discussion follows.

  • Regarding the status of all the rules related to HB 7, the chart on TDI´s website is updated regularly and is located at http://www.tdi.state.tx.us/wc/rules/planning/ruleschart.html. Updates about rules will be included in future IWG meetings.
  • Regarding "ghost networks" and regulations about them, please see the 12/7/2005 Commissioners´ Bulletin B-0071-05 regarding "informal" networks at this link http://www.tdi.state.tx.us/bulletins/b-0071-05.html. The Texas Medical Association (TMA) agreed to forward the bulletin to its members, and DWC will send it to their provider e-mail list also. Ghost networks and TDI´s activities in relation to them will be a discussion topic at a future IWG meeting. Also, TDI will develop FAQs and key bullet points for doctors about ghost networks to include on the website. TMA and the Texas Hospital Association agreed to ask their members for additional suggestions for educational materials as well.
  • Regarding how the rules will address "network adequacy," TDI will present more information about how the WC network application addresses network adequacy at a future meeting, as well as summary information from the applications. The issue of whether a regional network is a subgroup or a separate network will also be discussed.
  • Regarding the acknowledgment form signed by the employee, members were asked to review the sample form provided in the application packet and send comments to TDI ( see copy attached to these notes). The form and how it is working will be a discussion topic at a future IWG meeting. Audrey agreed to have the injured workers´ focus group review the form also.
  • Regarding the network applications, TDI will provide as much aggregated information as possible to the group before or at the February meeting.
  • Suggested future meeting topics include: the "disability management" model and its components - treatment guidelines, treatment planning, the role of the designated doctor, and return to work; IRO guidelines; pre-authorization; complaint trends; reports from other working groups about related topics.

Please send suggestions for additional topics or any questions to WCNET@tdi.texas.gov. When sending e-mails to this address, please include "Informal Working Group" or IWG in the subject line.

The next IWG meeting will be February 1, 2006, from 10:30 a.m. to noon in Room 100 of the Hobby Building.

For more information, contact:

Last updated: 9/6/2014