276.6
(a) The Public Counsel adopts by reference the Notice of Injured Employee Rights and Responsibilities in the Texas Workers’ Compensation System (Notice) in accordance with Labor Code §404.109. (b) The Notice shall be distributed by the Texas Department of Insurance, Division of Workers’ Compensation (Division). (c) The Notice may be obtained from the: (1) Office […]
10.84
In addition to the duties and requirements placed upon treating doctors under Insurance Code Chapter 1305, concerning Workers’ Compensation Health Care Networks, and this chapter, a doctor designated as a treating doctor by a network must comply with Labor Code §§408.0041(c) and (g), concerning Designated Doctor Examination; 408.025(c), concerning Reports and Records Required from Health […]
10.85
(a) Selection of treating doctor. An injured employee who lives within the service area is entitled to the employee’s initial choice of a treating doctor from the list provided by the network of all treating doctors under contract with the network who provide services within the service area in which the injured employee lives in […]
10.86
Each network must establish and maintain telephone access logs for calls received other than during regular business hours that accurately record the following: (1) the date the network received the telephone call; (2) detailed information necessary for the network to respond to the telephone call; (3) the date the network responded to the telephone call; […]
10.80
(a) All services specified by this section must be provided by a provider who holds a current appropriate Texas license, unless the provider is exempt from license requirements. (b) The network must ensure that the network’s provider panel includes: (1) an adequate number of contracted treating doctors and specialists, who must be available and accessible […]
10.81
(a) A network must develop and maintain a continuous and comprehensive quality improvement program designed to monitor and evaluate objectively and systematically the quality and appropriateness of health care and network services, and to pursue opportunities for improvement. The quality improvement program must include return-to-work and medical case management programs. The network must dedicate adequate […]
10.82
(a) Networks must have a documented process for selection and retention of preferred providers sufficient to ensure that preferred providers are adequately credentialed. At a minimum, a network’s credentialing standards must meet the standards promulgated by the National Committee for Quality Assurance (NCQA) or URAC to the extent that those standards do not conflict with […]
10.83
(a) Each network must adopt treatment guidelines, return-to-work guidelines, and individual treatment protocols, which must be evidence-based, scientifically valid, outcome-focused, and be designed to reduce inappropriate or unnecessary health care while safeguarding access to necessary care. (b) An insurance carrier or network may not deny treatment for a compensable injury solely because its treatment guidelines […]
10.61
(a) The employees of an employer who elects to contract with an insurance carrier for network health care services, and who live within the network’s service area, must obtain medical treatment for a compensable injury from in-network providers, except as provided in Insurance Code §1305.006(1) and (3), concerning Insurance Carrier Liability for Out-of-Network Health Care; […]
10.62
(a) If an employee asserts that he or she does not currently live in the network’s service area, the employee may request a review by contacting the insurance carrier and providing evidence to support the employee’s assertion. (b) An insurance carrier must review the employee’s request for review, including any evidence provided by the injured […]