repeal of treatment planning rule

<MedicalBenefits@tdi.state.tx.us> 6/13/2007 7:15 PM >>>The Texas Department of Insurance, Division of Workers' Compensation has announced that repeals of two workers' compensation rules will be submitted to the Texas Register. The rules are the Prospective Review of Medical Care Not Requiring Preauthorization (PRM) rule and the Treatment Planning rule.The PRM rule is no longer needed due to the adoption of treatment guidelines for the workers' compensation system. To view the news release concerning PRM, please click on the following link: http://www.tdi.state.tx.us/wc/news/2007/news200776.html .The treatment planning rule was adopted last December as one of several disability management rules but the effective date was postponed due to concerns expressed by system participants. The repeal of the treatment planning rule will not affect the other disability management rules including those adopting treatment and return-to-work guidelines for Texas. To view the news release concerning treatment planning, please click on the following link:
http://www.tdi.state.tx.us/wc/news/2007/news200779.html ."June 12, 2007
TDI Will Change Disability Management Requirements
FOR IMMEDIATE RELEASEJune 12, 2007News Release
FOR MORE INFORMATIONJohn Greeley @ (512) 804-4202
Austin, TX – The Texas Department of Insurance (TDI) announced that a workers’ compensation rule to require treatment planning for injured employees (28 Texas Administrative Code §137.300) will be repealed. This rule was adopted along with other disability management rules in December, 2006. The effective date for treatment planning was postponed until September 1, 2007, however, as the agency attempted to address ongoing concerns from system participants.
A repeal of the treatment planning rule will be submitted to the Texas Register. Since the rule has not become effective, system participants will not be required to meet the rule’s requirements.
“System participants support the concept of treatment planning, but many also agree that implementation will require significant business and administrative process changes,” Commissioner of Workers’ Compensation Albert Betts said. “We were concerned that participants would not be able to initiate treatment planning without some lapses in care for injured employees.”
Dr. Howard Smith, Medical Advisor for TDI’s Division of Workers’ Compensation, said TDI plans to work with health care providers and insurance carriers on a treatment planning pilot program.
“This treatment planning pilot will allow us to identify opportunities for improved communication and efficient delivery of appropriate medical care,” Smith said.
Since publication of the adopted disability management rules, system participants expressed the need for additional time to establish processes to appropriately address required treatment planning. Participants also argued for additional time to communicate and develop treatment planning parameters that are mutually acceptable to health care providers and insurance carriers.
Disability management rules requiring the use of workers’ compensation treatment guidelines and return-to-work guidelines became effective May 1, 2007 and will remain in effect."

TREATED BAD BY INSURANCE CARRIER ?

I see injured workers every day. As a treating doctor, daily I am confronted with insurance carriers who deny, dispute, foot drag, and some, act in a way that may constitute "bad faith".

Patients get upset. But, how will things get changed? Patients who are unrepresented by attorneys, patients who cannot afford to hire attorneys specializing in Work Comp, but who are advised by ombudsman, often lose Benefits Review Conferences (BRC) and Contested Claims Hearings (CCH), and, after reading the decisions, I believe these folks ought NOT to have lost, because there is a preponderence of medical opinion in their favor.

Perhaps you alone cannot change the system, but I contend that if ENOUGH weight is brought to bear on the Department of Insurance about perceived wrongdoing by insurance carriers, and enough media people (television stations, radio, newspapers, bloggers) bring the issue to the public attention, there is certainly a stronger possibility that some positive changes will occur.

If no one complains, or not enough complain, the system will get worse and worse and worse.

Perhaps the easiest way to contact the Texas Department of Insurance, Work Comp division, is via e-mail WorkersComp@tdi.state.tx.us .

To write a snail mail letter of complaint :
Texas Department of Insurance
Division of Workers' Compensation
7551 Metro Center Drive
Suite 100
Austin, TX 78744-1609
You may also contact the Field Office nearest you