TX DWC Publishes Annual WC Report

Dallas, TX (CompNewsNetwork) -The Texas workers' compensation system has undergone significant changes in the five years since the passage of House Bill (HB) 7 by the 79th Legislature in 2005. Since 2005, the Texas Department of Insurance (TDI), Division of Workers' Compensation (TDI-DWC) has implemented a considerable number of initiatives designed to reduce and/or stabilize costs and improve injured employee outcomes (such as quality of care, access to care, return-to-work outcomes, etc.). These initiatives include

• the adoption of evidence-based treatment and return-to-work guidelines for non-network claims;

• the certification and continued monitoring of workers' compensation health care networks certified by TDI;

• the adoption and implementation of Medicare-based fee guidelines for professional services, inpatient and outpatient hospital services and ambulatory surgical center services;

• the development of a closed pharmacy formulary proposal – one of the first in the nation for workers' compensation;

• the implementation of new income benefit changes, including new work-search requirements for employees eligible for Supplemental Income Benefits and changes in the calculation of the State Average Weekly Wage, which affect the maximum amount in income benefits received by injured employees;

• the implementation of rules and processes to streamline dispute resolution and reduce the amount of time it takes to resolve income and medical fee and necessity disputes;

• the utilization of a new enforcement structure to help align the enforcement activities of TDI-DWC with the rest of TDI;

• the development and implementation of a return-to-work reimbursement program for Texas employers;

• the implementation of Performance Based Oversight (PBO), which assesses the performance of insurance carriers and health care providers in meeting the key regulatory goals established by the Commissioner of Workers' Compensation;

• ongoing monitoring of reform efforts through the development of several statutorily required biennial reports and rate hearings; and

• the utilization of consensus-based rulemaking procedures that promote communication and foster greater coordination with stakeholders about proposed rules.

While almost all of the key provisions of HB 7 have been implemented by TDI and TDI-DWC, it is too early to effectively gauge the full impact of this legislation. However, the data collected thus far has indicated that the reforms both in 2001 by HB 2600 and in 2005 by HB7 have made significant improvements in the system as a whole. While the long-term effect of certain components of these reforms, such as the impact of certified workers' compensation health care networks, may not yet be fully realized, it is important to establish a baseline by which policymakers and system participants may measure the relative health of the system and the impact of legislative or regulatory reforms in the future.

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