134.520
The commissioner of workers’ compensation adopts a closed formulary as defined in §134.500(3) of this title (Definitions). The closed formulary applies to all drugs that are prescribed and dispensed for outpatient use. The provisions of this 134.520 adopted to be effective January 17, 2011, 35 TexReg 11344; amended to be effective November 29, 2024, __ […]
134.530
(a) Applicability. The closed formulary applies to all drugs that are prescribed and dispensed for outpatient use for claims not subject to a certified network. (b) Preauthorization for claims subject to the division’s closed formulary. (1) Preauthorization is only required for: (A) drugs identified with a status of “N” in the current edition of the […]
134.540
(a) Applicability. The closed formulary applies to all drugs that are prescribed and dispensed for outpatient use for claims subject to a certified network. (b) Preauthorization for claims subject to the division’s closed formulary. Preauthorization is only required for: (1) drugs identified with a status of “N” in the current edition of the ODG Treatment […]
134.550
(a) The purpose of this section is to provide a prescribing doctor or pharmacy an ability to obtain a medical interlocutory order when preauthorization denials of previously prescribed and dispensed drugs excluded from the closed formulary pose an unreasonable risk of a medical emergency as defined in §134.500(7) of this title (Definitions) and Insurance Code […]
131.14
(a) If the insurance carrier disputes the accuracy of the first responder’s annual certification under Labor Code §408.1615(g), the insurance carrier must provide a copy of the annual certification along with supporting evidence to the commissioner and to the first responder. (b) Upon review of the information in subsection (a) of this section, the commissioner […]
131.13
(a) An insurance carrier may suspend the payment of lifetime income benefits to a first responder during and for a period in which: (1) The first responder fails to complete the annual certification as required by §408.1615(e). (2) The first responder, without good cause, fails to attend a designated doctor examination as required by §408.0041(j). […]
131.12
(a) Requirement. A first responder receiving lifetime income benefits under §408.1615 must file a certification with the insurance carrier annually. (b) Content. The certification must state that the first responder was not employed in any capacity during the preceding year. (c) Method and Timing. The first responder must submit the certification to the insurance carrier […]
131.11
This subchapter applies to a first responder who sustains a serious bodily injury: (1) that is an injury described under Labor Code §408.1615; (2) in the course and scope of the first responder’s employment or volunteer service as a first responder; and (3) that renders the first responder permanently unemployable. The provisions of this §131.11 […]
131.10
(1) “First responder” means “first responder” as defined in Labor Code §408.1615. (2) “Serious bodily injury” means “serious bodily injury” as defined in Penal Code §1.07. The provisions of this §131.10 adopted to be effective November 21, 2024, __ TexReg ___.
131.4
(a) Upon the request of an injured employee entitled to lifetime income benefits (LIBs) as defined in the Act, the insurance carrier and an injured employee may agree to change the frequency of LIBs payments from the standard weekly period to a monthly period. The agreement to change the payment frequency must be in writing […]