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TX DWC Proposes Informal Pharmacy Fee Guideline Rules

26 Oct, 2010 WorkersCompensation.com

                               
Austin, TX (CompNewsNetwork) - The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) is accepting comment on two drafts of an informally proposed rule to amend 28 Texas Administrative Code (TAC) 134.503 regarding the Pharmacy Fee Guideline. The informal proposal rule drafts were posted on October 25, 2010 and may be viewed at http://www.tdi.state.tx.us/wc/rules/drafts.html. The comment period on the informal proposal closes Monday, November 15, 2010 at 5 p.m. [Central Standard Time (CST)].
 
The purpose of the rule is to implement statutory amendments to Texas Labor Code §408.028 and §413.011 under House Bill 7, enacted by the 79th Legislature, Regular Session (effective September 1, 2005) and House Bill 473, enacted by the 80th Legislature, Regular Session (effective September 1, 2007). The informal drafts update the rule to conform to requirements in the Texas Labor Code and clarify the applicability of the pharmacy fee guideline.
 
On May 20, 2010, TDI-DWC submitted a request for an opinion to the Office of the Attorney General regarding “the authority of workers' compensation insurance carriers to pay for a prescription drug, medicine, or other remedy at a lower fee rate than the fee rates allowed under the Texas Department of Insurance, Division of Workers' Compensation's fee guidelines after January 1, 2011”. A copy of the request (RQ-0890-GA) is available at:
https://www.oag.state.tx.us/opinions/opinions/50abbott/rq/2010/pdf/rq0890GA.pdf.
 
TDI-DWC requests workers' compensation system participants' input on both Draft A and Draft B informal working draft rules. Both of these rule drafts are dependent on the outcome of the Office of the Attorney General's opinion. TDI-DWC contracted with Milliman for professional actuarial services to assist in developing the revised fee formula in Draft B. The Milliman Report, which is the basis for the calculation of the revised fee formula, is available at:
http://www.tdi.state.tx.us/wc/fee/documents/rxreimcomp.pdf.
 
TDI-DWC is anticipating an emergency rule adoption due to the short time frame available to adopt a Pharmacy Fee Guideline rule and have it become effective by January 1, 2011.
 
These informal working drafts are not a formal rule proposal. Accordingly, comments will not be treated as formal public comment for the purposes of the Administrative Procedure Act. The informal working drafts contain drafting notes and formatting which will be changed as necessary to comply with the Texas Register formatting.
 
Informal comments may be submitted by e-mailing InformalRuleComments@tdi.state.tx.us or by mailing or delivering the informal comments to Maria Jimenez at:
Texas Department of Insurance, Division of Workers' Compensation
Workers' Comp Counsel MS - 4D
7551 Metro Center Drive, Suite 100
Austin, Texas 78744 -1645
 
An informational hearing for system participants on these informal proposals will be held on Tuesday, November 16, 2010 at 9 a.m. CST in the Tippy Foster Room of the TDI-DWC Central Office, 7551 Metro Center Drive, Suite 100 in Austin.

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