Texas Self-Insurance Association

Labor Code §405.0026 requires the Commissioner of Insurance to adopt an annual research agenda for the Workers’ Compensation Research and Evaluation Group (REG) at the Texas Department of Insurance (Department). Labor Code §405.0026 also requires the Department to publish a proposed research agenda in the Texas Register for public review and comment and the Commissioner of Insurance to hold a public hearing on the proposed research agenda if requested by a member of the public.

In September 2006, the REG posted a public request to stakeholders and the general public for research agenda suggestions on the Department website. The REG also made inquiries and requests of legislative offices for input to develop the Fiscal Year (FY) 2007 Research Agenda. After reviewing responses from the general public, stakeholders, and legislative offices, the REG developed a proposed FY 2007 Research Agenda using the following criteria:

1. Is the proposed research project required by statute or likely to be part of an upcoming legislative review?

2. Will the results of the proposed research project address the information needs of multiple stakeholder groups and/or legislative committees?

3. Are there available data to complete the project or can data be obtained easily and economically to complete the project?

4. Does the REG have sufficient resources to complete the project within FY 2007?

Based upon the responses received and the criteria outlined above, the REG proposes the following set of projects for the FY 2007 Research Agenda for public review and comment.

1. Development of the Workers’ Compensation Health Care Network Report Card required under Insurance Code §1305.502 and Labor Code §405.0025;

2. An update of the FY 2006 REG analysis of access to medical care provided under the Approved Doctors List (ADL), including an initial analysis of access to medical care under Department-certified workers’ compensation health care networks;

3. A survey of health care providers regarding their knowledge of the 2005 legislative reforms and their perceptions of the Texas workers’ compensation system and workers’ compensation health care networks;

4. An update of the FY 2006 REG analysis of return-to-work outcomes for injured workers using data from the Texas Workforce Commission;

5. Continuation of the development of a Designated Doctor and peer review doctor monitoring plan in conjunction with the Department’s Division of Workers’ Compensation;

6. An analysis of the frequency, type, and outcome of peer reviews performed on behalf of insurance carriers using the results of the Department’s Division of Workers’ Compensation’s peer review data call;

7. An update of the FY 2005 REG analysis on medical costs and utilization of care;

8. An update of the FY 2006 REG analysis of medical bill and compensability claim denial trends in the Texas workers’ compensation system, including an initial comparison of medical billing denial rates both in- and out- of networks;

9. An initial examination of the frequency of both employers and workers’ compensation claims participating in networks; and

10. An analysis of the adequacy of income benefits paid to injured workers as a result of their work-related injuries.

REQUEST FOR PUBLIC COMMENT OR PUBLIC HEARING. To be considered, written comments on the proposed FY 2007 Research Agenda must be submitted no later than 5:00 p.m. on January 2, 2007, to Gene C. Jarmon, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comments must be simultaneously submitted to Amy Lee, Director, Workers’ Compensation Research and Evaluation Group, Mail Code 105-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. Any request for a public hearing should be submitted separately to the Office of the Chief Clerk before the close of the public comment period. If a hearing is held, written and oral comments presented at the hearing will be considered. For questions regarding the proposed agenda please contact Amy Lee at wcresearch@tdi.state.tx.us.