Texas Self-Insurance Association

Pursuant to new rules, Texas Administrative Code (TAC) Title 28, Chapter 133, Subchapter D (related to Dispute of Medical Bills), §§133.305, 133.307, and 133.308, IRO review and assignment functions have been consolidated within the HWCN Division of TDI.  Previously, IRO assignments related to the medical dispute resolution process for medical necessity were handled by the DWC.  These IRO assignments will transfer from the DWC to the HWCN Division effective January 15, 2007.  Section 133.308(a), related to medical dispute resolution (MDR) by IROs, provides that all IROs performing review of health care under the Labor Code and Insurance Code, regardless of where the independent review activities are located, shall comply with §133.308.  The new rules may be accessed on the TDI-DWC website at: http://www.tdi.state.tx.us/wc/rules/tableofcontents/rulesoptions.html.

See the attached bulletins for IROs, HCPs and URAs

As an injured employee in Texas, you have the right to free assistance from the Office of Injured Employee Counsel (OIEC). OIEC is a state agency that is responsible for assisting injured employees with their claim in the workers’ compensation system.

You can contact OIEC by calling its toll-free telephone number: 1-866-EZE-OIEC (1-866-393-6432). More information about OIEC and its Ombudsman Program is available at the agency’s website (www.oiec.state.tx.us).

Alternative Solutions For General Acute Care Hospitals in each Non-Rural County
Access Plans for WC Networks

A network needs to have a sufficient number of hospital providers to meet choice, access, and quality needs in a nonrural county; if it does not, the network’s access plan must include:

1.)    A listing of contracted providers which notes the non-network hospitals in the county where each provider has admitting privileges, and
2.)    The reason or reasons, based on lack of services available, for utilizing non-network acute hospitals, and
3.)     A listing of contracted alternative, non-acute care facilities that can provide required surgical services.