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Workers' Compensation Networks Informal Working Group (March 9, 2006)

March 9, 2006
1 p.m. to 4:30 p.m.
Hobby Building - Room 100

Goals of the workers´ compensation system of Texas

  • Each employee shall be treated with dignity and respect when injured on the job;
  • Each injured employee shall have access to a fair and accessible dispute resolution process;
  • Each injured employee shall have access to prompt, high-quality medical care within the framework established by the Texas Workers´ Compensation Act;
  • Each injured employee shall receive services to facilitate the employee´s return to employment as soon as it is considered safe and appropriate by the employee´s health care provider.

Purpose of the Workers´ Compensation Health Care Network Act

  • Authorize the establishment of workers´ compensation health care networks for the provision of workers´ compensation medical benefits;
  • Provide standards for the certification, administration, evaluation, and enforcement of the delivery of health care services to injured employees by networks.

Agenda - March 9, 2006

DWC Stakeholder Meeting regarding Pre-proposal Draft Rules on Medical Dispute Resolution

Agenda Item Presenter
  • Welcome
Audrey Selden
Senior Associate Commissioner
Consumer Protection
  • Medical Dispute Resolution - Pre-proposal Draft Rules
    • Brief description of purpose
    Open discussion and questions
Allen McDonald
Acting Deputy Commissioner
Workplace and Medical Services
WCNIWG Meeting
Antitrust statement Audrey Selden
Review of ground rules Margaret Lazaretti
Deputy Commissioner
Health and Workers´ Compensation Network Certification and Quality Assurance Division (HWCN)
Discuss employee acknowledgement form and appropriate notice to employees Margaret Lazaretti
Discuss educational materials and outreach strategies Audrey Selden
Next meeting: March 22, 1 p.m. to 4:30 p.m.

Meeting Notes - March 9, 2006

Audrey Selden welcomed the group and members introduced themselves. Audrey reminded the group of the antitrust statement and ground rules. The next meeting is set for March 22 from 1 p.m. to 4:30 p.m. in Room 100 (the big room), Hobby Building.

Margaret Lazaretti reported that 17 applications for workers' compensation networks have been received, and the first network may be certified by the end of March.

Margaret gave an overview of the notice of network requirements and the acknowledgment form. Key points include:

  • Who is subject to network requirements? Current employees who live in the service area of the network, and who receive notice of network requirements from the employer.
  • Disputes about the definition of "live" will be handled via the carrier dispute process, with appeal available to the TDI complaint process.
  • Samples of materials provided to employees about their health coverage, referred to as member handbooks or evidences of coverage, that employers and carriers may wish to consider when designing their network requirements documents may be accessed via links on the Employees Retirement System web page at http://www.ers.state.tx.us/Insurance/Hlth_Dntl_Links.htm#HMOs. Copies of the member handbooks used by Firstcare, Community First Health, and Mercy Health Plan of Missouri were provided to the members. Although the requirements for certified network notices are different, the language style and layout may be helpful for designing WC network documents.
  • The 15 mandatory requirements or pieces of information required to be in the notice are information that all employees need to know about the network.

The PowerPoint presentation on these requirements is being revised; when completed, it will be posted on the WC networks web page at http://www.tdi.texas.gov/wc/wcnet/index.html.

Regarding the question of how to determine whether an employee did not receive the notice, or did not sign it, employers are required to keep records of when and how notices were provided to employees. Regarding how to provide the required information to employees who work at construction sites, on oil rigs, or other places where there is limited space to post notices, employers could possibly post a sign with the 15 mandatory pieces of information with directions about where to go/who to contact for full information. Members were asked to send their specific questions regarding the notice requirements to wcnet@tdi.texas.gov.

Two recent Commissioner's bulletins regarding networks were provided to the members:

  • B-0004-06 re: Updates to URA certification applications for utilization review agents that perform utilization review for workers' compensation health care networks
  • B-0005-06 re: Voluntary networks or "informal networks"

Members received updated drafts of the two publications about WC networks. TDI asked the members to please review the draft publications again and send comments to wcnet@tdi.texas.gov. The publications will be posted on the TDI website when the networks are "live." Audrey explained that TDI has drafted an outreach plan to consumers/employees, employers, health care providers, and workers' compensation carriers, agents, and workers' compensation networks. Key points include:

  • Publications will be translated into Spanish, Chinese, Korean, and Vietnamese.
  • The web resource page will include an audio workshop and PowerPoint presentation.
  • A series of FAQs is coming soon.
  • The WC networks flier was tested for readability with a group of injured workers. We will continue to test written materials to make sure they are understandable for a ninth-grade or below reading level.
  • Materials will always be made available in print as well as via the website.

Audrey emphasized that TDI wants to partner with all system participants to distribute information about WC networks. Please send suggestions and opportunities to wcnet@tdi.texas.gov. All system participants are encouraged to provide their suggestions for improvement. Success happens if all system participants know about and understand these important changes.

Members' suggestions to TDI included:

  • Partnering with the National Federation of Independent Businesses to reach small businesses
  • Including return-to-work information in the outreach plan
  • Utilizing public service announcements
  • Asking to be a presenter at the June 2006 Independent Agents of Texas (IAT) meeting in Houston
  • Asking the IAT to share information about Texas networks with their offices in other states in order to reach employees who work for Texas companies in those states
  • Distributing information to new companies that register with the Secretary of State's office
At this time, the WCNIWG is the only WC stakeholder group that has been created, and a list of members, meeting agendas, and meeting notes are posted on the TDI website at http://www.tdi.texas.gov/consumer/wcnetiwg.html. TDI does invite stakeholders to participate in discussions about rules under development, and dates and times for those meetings are posted on the TDI website at http://www.tdi.texas.gov/wc/rules/tableofcontents/rulesoptions.html. Additionally, TDI plans to form several external work groups to assist with the implementation of initiatives identified in the Division of Workers' Compensation's Strategic Management Plan. That plan and the formation of associated external work groups will be posted on the agency's website in the near future. TDI will continue to keep the WCNIWG informed as additional work groups are formed to address specific issues in the workers' compensation system.

Bonnie Bruce from Representative Solomon's office complimented the communication and cooperation among all the groups represented at the meeting.

Links to other information of interest:

From here, you can find information about stakeholder meetings, hearings, proposed and adopted rules

  • TDI has posted an update about HB 7 on the website. To view, please click on http://www.tdi.texas.gov/wc/transition/twcc.html then click on link to House Bill 7 Implementation Update (February 2006).

Next meeting: March 22, 1 p.m. to 4:30 p.m., Room 100, Hobby Building

For more information, contact:

Last updated: 10/20/2015