June 20, 2016 WC Bulletin No. 2016-10 To: Persons Interested in Workers’ Compensation Issues From: Steve Nichols, Manager, Workers’ Compensation Services Re: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting This bulletin is intended to provide Insurance Council of Texas members with a report on the Texas Department of Insurance’s Division of Workers’ Compensation April1 4, 2016 Quarterly Insurance Carrier Meeting. The Division of Workers’ Compensation (DWC) held the Quarterly Insurance Carrier Meeting at the DWC’s central office in Austin, Texas. Executive Summary Commissioner of Workers’ Compensation Ryan Brannan made brief opening remarks. See Pages 2 - 5 of the bulletin for a summary of the commissioner’s remarks. DWC staff presented updates on:

(1) Complaint and Data Monitoring Update: Teresa Carney, the DWC’s Director of System Monitoring & Oversight, provided an update on complaints received and acted upon by the DWC. See Pages 5 – 9 of the bulletin.

(2) Enforcement Update: Marisa Lopez Wagley, the DWC’s Deputy Commissioner of

Enforcement and Toya Lutz, the DWC’s Director of Enforcement, provided an update on workers’ compensation enforcement activities. See Pages 9 – 12 of the bulletin.

(3) Office of Medical Advisor Activities Update: Mary Landrum, Director of Health Care Business Management, provided an update on the activities of the Office of Medical Advisor (OMA) and the Medical Quality Review Panel (MQRP). See Page 12 of the bulletin.

(4) Medical Fee Dispute Resolution Update: Martha Luevano, the DWC’s Director of Medical Fee Dispute Resolution, and Greg Arendt, the Team Leader for the Medical Fee Dispute Resolution Team, provided an update on the medical fee dispute resolution process.

See Pages 12 through 14 of the bulletin.

(5) DWC Rule-Making Projects Update: Emily McCoy, the DWC’s Director of the Office of Workers’ Compensation Counsel, provided a rule-making projects update.

See Pages 14 through 16 of the bulletin. A Question and Answer Session was held at the end of the meeting. See Page 16 of the bulletin.

WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 The following meeting agenda items were presented and discussed during the meeting: Opening Remarks by Commissioner of Workers’ Compensation Ryan Brannan Commissioner of Workers’ Compensation Ryan Brannan welcomed the meeting participants. The Commissioner reported on a two hearing, March 22, 2016 and March 23, 2016, at the Texas House of Representatives’ Business & Industry Committee at which he and DWC staff testified. The Commissioned noted that he and staff testified on the following topics:

(1) Designated Doctor Process;

(2) Life Time Income Benefits and Death Benefits; and

(3) Compounded Drugs. The handouts and written testimony from the hearings are available at the following website links: March 22, 2016 Hearing Date – Includes written testimony of other individuals who testified. March 23, 2016 Hearing Date – Includes written testimony of other individuals who testified. Note: Several other individuals testified at both the March 22, 2016 and March 23, 2016 hearings in addition to Commissioner Brannan. Written testimony was submitted by most of the other witnesses. Jessica Corna, the Public Injured Employee Counsel and agency head for the Office of Injured Employee Counsel testified before the committee on March 23, 2016 about the activities of her agency. Archived videos for both the March 22, 2016 and March 23, 2016 hearings are available. Commissioner Brannan reported that he also appeared before the Texas House of Representatives’ Insurance Committee on March 30, 2016 and, along with the DWC’s Director of System Monitoring & Regulation – Teresa Carney, testified about workers’ compensation insurance fraud. Note: An archived video of the March 30, 2016 hearing is available on the Texas House of Representative’s website. The Insurance Committee also took testimony on the Texas Mutual Insurance Company’s contract with the Travis County District Attorney’s Office for the prosecution of insurance fraud cases. Since 2001, TMIC has had a funding agreement in place with the Travis County District Attorney’s Office to prosecute workers’ compensation) fraud cases filed by TMIC pursuant to §2054.455 of the Texas Insurance Code. An overview of the Texas Mutual Insurance Company’s agreement and the Texas Department of Insurance’s Fraud Unit was submitted and considered by the committee. Commissioner Brannan announced the following organizational changes and staff editions in the Legal, Designated Doctor and Health Care Management, Records Management, Communications and External Relations Sections of the DWC:

● The DWC enforcement section, previously managed by TDI, will resume being managed by DWC as part of a larger realignment of all DWC legal functions reporting to the Workers'

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016

Compensation Commissioner. I want to thank Insurance Commissioner David Mattax for his help in this endeavor,

Marisa Lopez-Wagley has been named Deputy Commissioner of the new DWC’s Enforcement Section. Marisa will be a great leader of DWC's enforcement team, all of whom I am pleased to report will continue in their current roles. Lopez-Wagley is currently serving as the DWC’s Acting General Counsel.

● Nick Canaday has been hired for the position of General Counsel. Canaday has many years of

workers' compensation experience, both in private practice and representing the Division of Workers' Compensation at the Attorney General's office. He assumed his new position on March 21, 2016.

● Mary Landrum has also been named the Director of Designated Doctor Operations. She will continue to oversee the Health Care Quality Review and Health Care Policy and Implemen-

tation program areas.

Dr. Defoyd will continue to serve as Director of Designated Doctor Education. Landrum and Dr. Defoyd will report to Joe McElrath, the DWC’s Deputy Commissioner of Business Process. For the designated doctor responsibilities. Landrum will continue to report to Matt Zurek, the DWC’s Executive Deputy Commissioner, for her responsibilities related to health care management. Martha Luevano’s position has been reclassified as a Director. She will serve as Director of Medical Fee Dispute Resolution and will report to Executive Deputy Commissioner Zurek.

● David Ekrut began serving as the DWC’s Director of Records Management and Support on

March 21, 2016. His responsibilities will include records processing, document imaging, project knowledge and support, and management of the records center. As part of these changes, Richard Ramirez transitioned back to records management.

Commissioner Brannan announced that he has taken steps to strengthen the DWC’s communications and external relations. The commissioner has created a Communications Team at DWC. The team will report to Barbara Salyers, the DWC’s Chief Deputy of Workers’ Compensation. The DWC’s Communications Team will work cooperatively with TDI’s Communications Team. Susan Criner, Kim McDonald, and Helen Vogel are part of the DWC's new Communications Team. Kate Sidora will continue to report to Angelia Johnson and provide expertise in event planning and outreach coordination. The commissioner also announced that Jeff Nelson has joined the DWC as Assistant Director of External Relations. Nelson will assist with external relations efforts. Commissioner Brannan also reported on the on-going litigation regarding air ambulance reimburse-ment disputes. He noted that Air Evac, a national air ambulance company, has filed a lawsuit in the United States District Court for the Western District of Texas in Austin, Texas seeking a court ruling that the federal Airline Deregulation Act of 1978 (ADA) preempts state law and rules that regulate the prices that air ambulance companies can charge for airlifting injured employees to hospitals to obtain

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 emergency medical care. The commissioner said a second air ambulance company, PHI Air Medical is seeking a similar ruling from the Travis County District Court seeking a similar ruling from a state judge. Air Evac is also seeking a ruling from the federal court that the ADA also preempts state law that prohibits the balanced billing of injured employees. Note: On September 8, 2015, a State Office of Administrative Hearings (SOAH) administrative law judge (ALJ) ruled that the Texas Department of Insurance’s Division of Workers’ Compensation (DWC) can regulate the fees that are paid for air ambulance services. The ALJ had also ruled that the fair and reasonable rate of reimbursement for air ambulance services is 149% of the rate set by Centers for Medicare and Medicaid Services for air ambulance transportation. The rulings were issued as part of a consolidated docket of disputes involving eight insurance companies who have been ordered by the DWC to pay the full amounts billed by PHI Air Medical for transporting 33 injured workers. The insurance companies in those cases have appealed the SOAH decision and are arguing that the rate of reimbursement should be at 125% of the Medicare rate as provided for by the DWC’s fee guidelines. On March 14, 2016, PHI Air Medical filed a petition to remove the state court suit filed against it to federal court. A removal petition is filed in federal court. Unless the federal court remands the case back to state court, the case will be tried in federal court. The insurers filed a motion with the federal court asking that the federal court remand the case back to state court on the basis that their suit was an appeal under the state’s workers compensation laws and does not raise federal law issues; the ADA preemption does not create a federal question; 28 USC §1445(c) bars removal; and PHI Air Medical’s removal petition was not filed timely. A hearing was held in federal court on these motions and a decision is expected on whether the case will be remanded back to state court. In both court cases, the air ambulance companies are asking for a judgment that the regulation of fees of providers in workers’ compensation cases contained in the Texas law, specifically Texas Labor Code – TEX. LABOR CODE §§401.001–401.026 and DWC rules – 28 TEX. ADMIN. CODE §134.1(a) and §§134.1, 134.203(d), and 134.203(f) – do not apply to air ambulance disputes because of the preemption provision in federal law. If there is no maximum fee guideline in state law, the fees for a health care provider for services to a workers compensation claimant must be fair and reasonable. Insurers believe that air ambulance fees are set forth in the fee guidelines. In the federal lawsuit, the plaintiff, Air Evac, is also seeking a judgment that TEX. LABOR CODE § 413.042(a), which prohibits a health care provider from making claims against a workers’ compen-sation claimant, is also preempted by the ADA. The practice of health care providers billing patients for services not covered by either health insurance or workers compensation is sometimes referred to as “balance billing”. Air Evac stated in their pleadings they want to “balance bill” injured employees for the amount of the air ambulance service bill that insurance companies do not pay. As of April 11, 2016, there are 484 medical fee dispute cases involving air ambulance services pending at the DWC. There are approximately 350 cases pending before SOAH, which were appealed to SOAH by the carrier after a DWC decision.

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20,016 Commissioner Ryan Brannan announced that he had directed that all air ambulance fee disputes be abated pending the outcome of ongoing litigation regarding federal preemption issues. Commissioner Brannan concluded his remarks by stating that the DWC wants to make sure that the PLNs are being used correctly. He noted that DWC staff would be monitoring the use of PLNs. Complaint and Data Monitoring Update Teresa Carney, the DWC’s Director of System Monitoring & Oversight, provided an update on complaints received to date for Calendar Year 2016 and the actions taken by the DWC on the complaints. Carney reported that the DWC has received 1,410 complaints from January 2016 to the first part of April 2016.

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

Carney said that the complaints received by the DWC included the following categories: ● Attendance 133 ● Indemnity Benefit Delivery 129 ● Communications 538 ● Medical Benefit Delivery 529 ● Fraud 1 ● Quality of Care 62 ● Other 17

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 Carney reported that the DWC has closed 427 complaints since the beginning of 2016. She noted that the DWC closed the complaints with the following disposition: ● 43 complaints confirmed; ● 321complaints closed but will be monitored; and ● 72 complaints closed as not being confirmed.

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016 Carney reported that it is taking the DWC an average of 100 days to complete complaint investigations. She noted that the DWC has adopted a new complaint form that is shorter than then the original form. Carney said the new form is not a required to be completed when a person or company is submitting a complaint. The new complaint form is available on the DWC’s website. Carney said that half of the complaints received by the DWC are submitted by external parties while the other half are received from with the agency.

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 Carney provided an update on insurance industry performance on the payment of initial temporary income benefits (TIBS). She reported that the timely payment of initial TIBs dropped to 79.70 percent in January 2016 but has otherwise remained at the 84 percentile compliance level. Carney said that she expects the insurance industry aggregate compliance rate for the timely payment of initial TIBs to go up due to 2016 Insurance Carrier Performance Based Oversight assessment process data time frame for insurance carriers being January 1, 2016 through June 30, 2016. Carney noted that the percentage of compliance reported by her reflects raw data with no investiga-tions done to determine if compliance rate was actually greater.

Source: Texas Department of Insurance’s Division of Workers’ Compensation, April 2016 Carney reported the insurance industry’s performance on the timely reporting of initial TIBs via the EDI data submission process was 92.34 percent in January. She noted that the compliance rate for the timely submission of the data has otherwise in the 96 percentile range.

Source: Texas Department of Insurance’s Division of Workers’ Compensation, April 2016

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 Carney provided an update on insurance industry performance on the processing of medical bills and timely reporting of medical billing data. She reported that the insurance industry processed and paid medical bills in a timely fashion 98.08 percent of the time during the first quarter of FY 2016 and 93.32 percent during the second quarter of FY 2016. Carney noted that the timely processing of medical bills has consistently been in the high 90 percentile range. Carney reported that the insurance industry’s performance on the timely reporting of medical billing data was 91.07 percent during the first quarter of FY 2016 and 84.64 percent during the second quarter. She noted that the DWC does not allow insurance carriers and their EDI vendors to submit corrected data during the PBO data time period.

Source: Texas Department of Insurance’s Division of Workers’ Compensation, April, 2016 Carney reported that several insurance carriers and/or their EDI vendors are still not reporting the National Provider Identifier number. She also reported that the date the medical bill was processed is being misreported by some insurance carriers. Carney noted that the compliance percentages represent raw data and do not take into account salary continuation and other issues. Carney said the DWC continues to find instances of underpayments of indemnity benefits. She noted that some insurers are submitting corrected data after payment of the additional amount of benefits owed but are not self-reporting the underpayments, subsequent payments or the correction of payment data. She said insurance carriers need to self-report these changes. Carney reminded everyone that self-reporting can mitigate any fines associated with the underpayment of income benefits. Carney noted that the DWC has constantly been discovering the following common compliance errors in insurance carrier performance audits that have contributed to the underpayment of benefits include:

• Failure to pay 75% of average weekly wage – 70% vs. 75% paid; • Failure to obtain a complete wage statement;

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016

• Failure to properly calculate average weekly wage; and • Failure to include non-pecuniary wages in average weekly wage.

Carney reported that the DWC has recently seen an instance where the insurance carrier paid Death Benefits at four times the rate. She noted that this was the first time the DWC has seen such a payment. Carney reminded everyone of the Plain Language Notice (PLN) monitoring project that the DWC has initiated. She reported that the DWC is seeing PLNs that do not comply with Rule 124.2. Carney said the DWC has discovered instances where a generic statement is being used instead of claim specific language that is concise. Carney reported that PLN1 notices are currently under review by the DWC. She noted that some insurance carriers are not submitting PLN1s to the DWC as required by the rule. Enforcement Update Marisa Lopez Wagley, the DWC’s Deputy Commissioner of Enforcement and Toya Lutz, the DWC’s Director of Enforcement, provided an update on workers’ compensation enforcement activities Lopez Wagley, the DWC’s Deputy Commissioner of Enforcement noted that TDI’s Compliance Division pursues strategies to improve efficiencies in market compliance and claim processing. She said in doing so, the DWC:

(1) Uses clear, express statutory authority for all enforcement cases; (2) Informs workers’ compensation stakeholders about compliance goals; (3) Partners with the DWC’s program areas to foster compliance; (4) Assists the Office of the Medical Advisor with medical quality reviews and enforcement

actions; and (5) Provides swift, appropriate actions for statutory and rule violations.

Lutz provided a workers’ compensation enforcement case status update and noted that the Workers’ Compensation Litigation Office had closed 51 cases and has 76 cases pending.

Case Status, 1st Quarter Calendar Year 2016

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 Lutz reported that as of the end of the first quarter of Calendar Year (CY) 2016 the DWC had 32 cases against insurance companies and 39 cases against health care providers pending review and action. She noted that there are 5 other cases pending.

Cases Pending by Subject Type, 1st Quarter Calendar Year 2016

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

Lutz also provided an overview of the workers’ compensation enforcement cases closed since the beginning of 2016. She said there were 38 insurance carrier, 9 health care provider, and 4 other enforcement subject type cases closed. Lutz also provided an overview of case closure by disposition and subject type.

Cases Closed by Subject Type, 1st Quarter Calendar Year 2016

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016

Cases Closed by Deposition Type in Calendar Year 2016

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

Trey Gillespie, Vice President of Workers’ Compensation for the Property Casualty Insurers Association of America asked why the DWC has only pursued a small number of non-subscriber failure to report non-subscription enforcement actions. Deputy Commissioner Lopez Wagley said the DWC’s Enforcement Program pursues enforcement in the cases that are referred to them and do not initiate enforcement actions on their own. Gillespie noted that there were a lot of internal complaints against insurance carriers and health care providers and asked if the DWC can identify non-compliant non-subscribing employers who have failed to report that they do not carry workers’ compensation insurance as required by the Texas Labor Code. Teresa Carney, the DWC’s Director of System Monitoring & Oversight, said the communications category of complaints may include internal complaints about the failure of a non-subscribing employer to report that they do not carry workers’ compensation insurance. Commissioner Brannan reported that the DWC gave non-compliant non-subscribers a grace period for the reporting of their non-subscriber status. He said that if the employer reported their non-subscription status within the grace period, they were not fined. The Commissioner noted that the DWC has seen an

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 increase in non-subscribing employers reporting that they do not carry workers’ compensation insurance during the grace period. He noted that it is premature to state what the response was to the grace period. Office of Medical Advisor Activities Update Mary Landrum, Director of Health Care Business Management, provided a report on the Calendar Year 2016 activities of the Office of Medical Advisor (OMA) and the Medical Quality Review Panel (MQRP). Landrum reported the following: ● 65 complaints have been forwarded to the OMA via external and internal complaint received

by the DWC; ● OMA investigated 65 complaints with 61 percent being closed without any action, 8 percent

being closed with a letter of education issued, 2 percent resulting in the initiation a medial quality review and 10 percent referred for enforcement action without any review by the MQRP; and

● OMA concluded 13 MQRP reviews. 62 percent of the cases were referred for enforcement

action and 28 percent were acted upon with other case dispositions that included letters of education, referrals to medical licensing boards and closures with no action.

Landrum reported that 19 OMA referrals had been received by the DWC’s Enforcement Program. She said 2 OMA enforcement cases were concluded with 1 consent order and 1 warning letter. Landrum noted that there were 30 OMA cases pending at the enforcement level and 6 pending at the State Office of Administrative Hearings. The Medical Quality Review Process document can be found on the DWC’s website and provides a detailed overview of the MQRP process. Medical Fee Dispute Resolution Update Martha Luevano, the DWC’s Director of Medical Fee Dispute Resolution (MFDR), and Greg Arendt, the Team Leader for the Medical Fee Dispute Resolution Team, provided an update on the medical fee dispute resolution disputes docketed, resolved and pending at the DWC. Luevano reported that the DWC had set a goal to reduce the number of active pending disputes from 939 to under 500 by September 1, 2016. She said the Medical Fee Dispute Resolution Team has gotten close to meeting that goal. Luevano noted that there are currently 572 active non-air ambulance disputes pending before the DWC. Luevano said the DWC has also set a goal to adjudicate 90 percent of the disputes within 90 days of the docketing of the disputes. She reported that for disputes received in January 2016, 96% were closed by April 1, 2016. Note: There are additionally 472 air ambulance disputes pending before the DWC as of April 11, 2016. That number is expected to grow due to the fact that Commissioner Brannan has directed staff to

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 abate all air ambulance disputes until such time the court litigation being pursued by air ambulance companies is concluded. The DWC receives an average of 30 air ambulance disputes per month. Arendt provided the following overview of the number of medical fee disputes docketed and closed during calendar years 2012 through 2016.

Total Dockets & Closures: Annual Trends

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016 Arendt provided an overview of the total number of active disputes pending at the DWC as of April 11, 2016.

Active Fee Disputes as of April 11, 2016

Source: Texas Department of Insurance, Division of Workers’ Compensation, April 2016

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 Arendt said the DWC has projected that there will be an estimated 4,000 medical fee disputes filed during Calendar Year 2016. He provided an overview of the percentage of each category of dispute that the DWC anticipates being filed in 2016. Note: See the table above. Luevano reminded insurers of the requirement that they submit a response for each medical fee dispute that is filed with the DWC. She noted that Rule 133.307(d)(2) requires an insurance carrier to:

(a) timely respond to a request for medical fee dispute resolution; (b) provide initial and appeal explanation of benefits (EOB) not included with the request for

medical fee dispute resolution; (c) provide the appropriate plain language notice if the EOB denial basis is compensability,

extent or liability; and (d) provide documentation that supports that an adverse determination was made in accordance

with Section 19.005 of the Insurance Code if the EOB denial relates to medical necessity. Luevano reported that the DWC does not receive a response from the insurance carrier 12 percent of the time and often does not receive all of the information required by Rule 133.307(d)(2). Luevano concluded the medical fee dispute resolution update by reminding everyone that the insurance carrier must, pursuant to Rule 133.307, provide initial and appeal EOBs not already provided by the requesting health care provider. She noted that the insurance carriers must also provide the plain language notice (PLN) if the EOB denial is compensability, extent or liability and provide the DWC with documentation that supports that an adverse determination was made in accordance with TDI Rule 19.2005, if EOB denial relates to medical necessity. DWC Rule-Making Projects Update Emily McCoy, Director of the DWC’s Office of Workers’ Compensation Counsel, provided an update on the DWC’s rule-making activities and projects. McCoy reported that the DWC currently has two rule-making projects underway: 28 Texas Administrative Code (TAC) §§134.204, 134.209 -134.250 (Medical Fee Guidelines) The proposed rule was published in the Texas Register on March 18,2016. The comment period closed on April 18, 2016. This is a non-substantive reorganization of medical fee guidelines for workers’ compensation-specific services. The DWC has also proposed repealing two rules that are no longer effective. The DWC’s goal with the non-substantive changes to 134.204 is to improve the organization of the rule and aid in compliance. The DWC also created a color-coded chart that shows a side-by-side comparison of existing the 28 TAC §134.204 and the new sections to serve as a guide on the non-substantive revisions for system participants.

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016 28 Texas Administrative Code (TAC) §§152.3, 152.4, & 152.6 (Attorney Fees) An informal draft rule was published April 1, 2016. The comment period closed on April 29, 2016. The rule, when amended, would increases the hourly rate for attorney services from $150 to $200 and for legal assistants from $50 to $65. The amended rule would also increase the amount of time attorneys can bill for prior to a BRC to encourage early resolution of disputes. The amended rule would also require attorneys to comply with the Texas Disciplinary Rules of Professional Conduct when withdrawing from a case. McCoy reported that the DWC has completed and following rule-making projects and adopted related revised or new forms: 28 TAC §132.13 (Burial Benefits) The rule became effective March 20, 2016. The rule implements SB 653 and increases the maximum amount of burial benefit reimbursement from $6,000 to $10,000. 28 TAC §132.7 (Death Benefits) The rule became effective March 20, 2016. The rule implements HB 1094 and allows an eligible spouse of a first responder to remarry and remain eligible for death benefits for life if the first responder suffered death in the course and scope of employment or while providing services as a volunteer. 28 TAC §104.1 (Rule Petitions) The rule became effective March 10, 2016. The rule implements HB 763, and defines an “interested person” as used in Government Code §2001.021, eliminates the requirement that a petitioner include a signature, and allows petitioners to submit the petition for rulemaking electronically. 28 TAC §129.3 & §129.11 (TIBs) The rule became effective February 28, 2016. The rule implements SB 901. Generally, people who earn below a certain wage receive a higher rate of TIBs (75 percent of pre-injury average weekly wage) for the first 26 weeks of disability. Before SB 901, that benchmark wage was $8.50 an hour. SB 901 increased the benchmark wage to $10 an hour. 28 TAC §110.108 & §110.110 (Phone Number Rule) The rule became effective December 14, 2015. The rule updates the DWC phone number on notices employers are required to post. Employees use the phone numbers to report possible exposure to communicable diseases or HIV or to inquire about, verify, or report the lack of coverage at construction sites.

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WC Bulletin No. 2016-10: Report on DWC’s April 14, 2016 Quarterly Insurance Carrier Meeting A Copyrighted Publication of the Insurance Council of Texas – June 20, 2016

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DWC Form-154 (Complaint Form) The new form was posted to the TDI website on March 1, 2016. The form, which is not a mandatory form, provides a simple, standardized form for filing complaints that can be used in addition to submitting complaints through the website or via fax or e-mail. DWC Form-048 (Travel Reimbursement Form) The revised form was posted to the TDI website on February 10, 2016. The form updates the travel reimbursement form used by injured employees and aligns it with 28 TAC §134.110 by allowing injured employees to request reimbursement from an insurance carrier for travel expenses to attend a Designated Doctor (DD) exam, Required Medical Examination, or post-DD exam when the exam is more than 30 miles from where the injured employee lives. Question & Answer Session There was a brief question and answer session. One meeting attendee had questions about what the DWC rules require insurance carriers to pay other than weekly benefits. Teresa Carney, the DWC’s Director of System Monitoring & Oversight, said she would review the rules and get back with the person who asked the question. A meeting attendee asked a question about whether or not the DWC will be auditing or otherwise reviewing health care providers who are return-to-work poor performers. Mary Landrum, the DWC’s Director of Health Care Business Management, said the DWC will use the Performance Based Oversight to identify and review return-to-work poor performers. A meeting attendee asked if the DWC planned on issuing a data call to obtain the necessary data to conduct the planned compounded drugs audit. Mary Landrum said that there will be no data call. She reported that the DWC will audit the Top 10 prescribers of compounded drugs and related data from the time period of September 1, 2014 – August 31, 2015. Landrum said the physicians selected for the audit will be selected using a “blind selection” process. Conclusion of Quarterly Insurance Carrier Meeting Carney thanked everyone for attending the meeting and announced that the next Quarterly Insurance Carrier Meeting will be held in July 2016.