Texas Issues Long-Awaited Rules on Workers' Comp Networks

Somehow over the busy December, I missed that Texas has at long last released rules governing how workers compensation networks can be set up in the state. The idea is to improve the quality of health care provided through the comp system (shouldn't be hard given the travesty that is the current Texas comp system) while also containing costs.Lucky for me, Joseph Paduda over at Managed Care Matters Blog did not miss the news. It was also covered by InsuranceJournal.com. Texas Department of Insurance Commissioner Mike Geeslin is quoted on the subject:

I want to address a concern that has been raised concerning network care, that it is merely a discount program that will cut corners to save money. If workers' comp health networks are viewed only as a tool to reduce medical costs, without adding any value to the rehabilitation and care of the injured employee, then the networks are headed to failure. Many employers and injured workers with whom I have spoken have emphasized the need for best value, not care on the cheap or, conversely, excessive care. The more effective medical care that a worker receives, the sooner he or she will be back to productive work or to a point where their injury is manageable.

To that end, our network rules incorporate a number of quality assurance tools. Workers' compensation networks are required to be credentialed and must demonstrate that they have a formal complaint and dispute process in place. The networks are also required to track return-to-work statistics to see how well they are getting injured workers back on the job.

In addition, TDI researchers will compile data to assess each network's performance on a yearly basis in the form of a "network report card." The report card will allow comparisons between networks on a variety of measures, including access to care, health-related outcomes, return-to-work outcomes, employee satisfaction with quality of care, and health care costs and utilization of care.

You can find a copy of the new rules here.Sexual Harassment, Pregnancy Discrimination, Age Discrimination, San Antonio, Employment Lawyer k