Testimonial Update on HB 7

Saturday, March 11, 2006 | 0

By Geoff Billings and Steve Nichols

On January 12, 2006, the Texas House of Representatives' Business & Industry Committee held a public hearing and received an update on the implementation of House Bill (HB) 7.

The Business & Industry Committee received updates from Texas Department of Insurance (TDI) Commissioner Mike Geeslin and Division of Workers' Compensation (DWC) Commissioner Albert Betts and, additionally, from the Public Injured Employee Counsel - Norman Darwin.

Others who testified were Amy Lee of the Texas Department of Insurance's Workers' Compensation Research and Analysis Group; Rick Levy, the Legal Director for the Texas AFL-CIO; and Dr. Charles Osborn, a Texas physician who is a critic of the Division of Workers' Compensation Medical Quality Review Panel.

Texas Insurance Commissioner Testifies; Market Conduct Studies Announced

Insurance Commissioner Mike Geeslin was the first witness heard from by the Business & Industry Committee. Geeslin commended the staff of the Texas Department of Insurance for their hard work that produced the workers' compensation healthcare network rules that were adopted in December of 2005.

Commissioner Geeslin announced that at the request of DWC Commissioner Albert Betts, insurance market conduct examinations would be conducted on insurance company claims handling practices. "These exams will test the cross divisional operations contemplated by HB 7," said Geeslin. "The market conduct exams will compliment past audits conducted by TWCC and the Division of Workers' Compensation." Geeslin said the exams may not result in fines being levied against insurers - in fact, what may be found is a health care provider or a group of providers who are incorrectly submitting their medical bills, health care provider fraud or injured employee fraud.

Commissioner Geeslin said the market examinations will hopefully identify the larger systematic problems and disputes that exist simply for the sake of argument. The commissioner said the exams may also help resolve disputes and close existing claims while giving the Texas Department of Insurance valuable information in establishing a performance based oversight system.

During the course of the public hearing, Representative Bill Zedler (R-Arlington) asked Commissioner Geeslin about what is being done to ensure that highly qualified doctors are being brought back into the Texas workers' compensation system. Representative Zedler also asked what the Texas Department of Insurance intended to do about third-parties who were approaching doctors to sign contracts for networks that would be used by many insurers. The contracts proposed a reimbursement arrangement of 85% of Medicare. Representative Zedler said it was his under-standing that the proposed 85% of Medicare reimbursement rate would not attract the highly qualified doctors and specialists that are essential to making the workers' compensation network process work.

Commissioner Geeslin responded by stating he told doctors that they do not have to sign a network contract if they do not like a network's proposed reimbursement rate. "I have told health care providers that to some extent, they hold all of the cards," said Geeslin. "They need to exercise their market force if they do not like the proposed reimbursement rates by not agreeing to join the network."

During the course of his testimony, Commissioner Geeslin noted that the cost per unit of workers' compensation insurance policies is trending downward.

Texas' Public Injured Employee Counsel Testifies

Insurance Commissioner Mike Geeslin introduced Norman Darwin, the Public Injured Employee Counsel and head of the new Office of Injured Employee Counsel (OIEC). Darwin provided the Business & Industry Committee members with his vision of the role the OIEC should play in the Texas workers' compensation system.

Darwin said his office intends to expose and focus some light on bad peer review doctors. He stated that several insurers always deny health care treatment regardless of the fact that a significant amount of the treatment is medically necessary and appropriate for the treatment of injured employees. He also announced that the OIEC will be collecting data on insurance company claims disputes patterns and hopes to be able to identify what insurers dispute the most claims, what kind of claims are being disputed, and how the disputes are being resolved.

Representative Helen Giddings (D-DeSoto), the Chair of the Business & Industry Committee, told Darwin that it would be very beneficial to the Texas Legislature if the OIEC could work with TDI's Workers' Compensation Research & Analysis Group.

Workers' Compensation Commissioner Provides Committee with HB 7 Implementation Update

Workers' Compensation Commissioner Albert Betts provided the members of the Business & Industry Committee with an update on the progress made implementing House Bill (HB) 7. Betts noted that the DWC initiated operations on September 1, 2006 and that a lot of work has been done by the staff in a period of just four months. He commended his staff and the staff of TDI for their hard work.

Betts said Commissioner Geeslin and he formed a Workers' Compensation Steering Committee comprised of staff from TDI and DWC. The steering committee has reviewed HB 7 and identified actions that need to be taken by TDI and the DWC, projects required to implement the new workers' compensation law, and issues requiring coordination between the two commissioners.

Commissioner Betts testified that he was in the process of making major organizational changes to the structure of the DWC. He said the changes being made were intended to better align the DWC with the functions, strategic direction, and goals of the new agency and law.

Betts reported that he had halted the operations of the Medical Quality Review Panel (MQRP) in November of 2005 after having received many complaints about the MQRP. He noted that he formed a work group comprised of stakeholders and staff from the Texas Board of Medical Examiners and Texas Board of Chiropractic Examiners to review the MQRP process. Betts added that the Public Injured Employee Counsel, Norman Darwin, was also a member of the workgroup.

The work group will provide a report to Commissioner Betts about the operations of the MQRP and may include recommendations on how to change the review process of the panel. The work group will also review how doctors are informed that they are under review, the review process, and the panel's new duties.

Commissioner Betts also discussed issues related to the reduction of the "flow of paper" within the Texas workers' compensation system, electronic billing and payment of medical bills, preauthori-zation issues, recent insurance company audits by the now defunct Texas Workers' Compensation Commission and DWC.

Other Witnesses Testify

Amy Lee, the Manager of TDI's Workers' Compensation Research & Analysis Group; Dr. Charles Osborn, a chiropractor from Waxahachie, Texas; and Rick Levy, the Texas AFL-CIO's legal director also testified during the hearing.

Amy Lee provided an overview of the TDI Workers' Compensation Research & Analysis Group's FY' 2006 research agenda. Lee said the following research projects will be undertaken during FY' 2006:

*Development of the Workers' Compensation Health Care Network Report Card required by Section 1305.502 of the Texas Insurance Code and Section 405.0025 of the Texas Labor Code;

*Analysis and report on injured worker survey to collect baseline information on issues relating to access to medical care, satisfaction with medical care, return-to-work outcomes, and functional outcomes prior to the implementation of certified workers' compensation health care networks;

*Creation of a research design to assess the impact of certified workers' compensation health care networks on both the cost and quality of medical care provided to injured workers, including a comparison of medical care provided prior to and after the implementation of networks, as well as a comparison of medical care provided to injured employees in and outside of networks;

*An analysis of access to medical care provided under the Approved Doctor List including the creation of a research design to track injured workers' access to medical care outside of certified workers' compensation health care networks;

*Update of a past study estimating employer participation in the Texas workers' compensation system;

*Update of a past study comparing the medical and indemnity costs of the various state workers' compensation programs, e.g. State Office of Risk Management, University of Texas System, Texas A&M University System, and Texas Department of Transportation.

*An analysis of the frequency, duration, and outcome of medical disputes prior to the implementation of certified workers' compensation health care networks;

*An analysis of return-to-work outcomes for injured workers using data from the Texas Workforce Commission;

*Development of a Designated Doctor and peer review doctor monitoring plan in conjunction with TDI's Division of Workers' Compensation;

*An analysis of medical bill and compensability claim denial trends in the Texas workers' compensation system; and

*An analysis of the frequency, duration, and outcome of income benefit dispute hearings prior to the implementation of HB 7.

Dr. Charles Osborn, a chiropractor from Waxahachie, Texas, also testified about his belief that he had been targeted by the Medical Quality Review Panel (MQRP) after having testified before the Texas House of Representatives Business & Industry Committee on behalf of several of his patients. Dr. Osborn testified that his application to be added to the Approved Doctor List (ADL) was unfairly denied. The doctor said he was initially granted a temporary exemption and allowed to treat injured employees. Dr. Osborn said his temporary exemption status was allowed to expire on his birthday and was withdrawn without any action having been taken on his application.

The Waxahachie doctor subsequently submitted a new application to be included on the ADL. His second application was denied due to a review conducted by the MQRP. Dr. Osborn said the summary of the workers' compensation claims reviewed contained in the MQRP did not resemble the entries in the medical records he prepared when treating the injured employees whose health care was reviewed.

Dr. Osborn said that he met with Insurance Commissioner Mike Geeslin and Workers' Compensation Commissioner Albert Betts in September of 2005 to discuss his case. He praised both commissioners and said they were looking into how he was treated by the MQRP.

Rick Levy, the Texas AFL-CIO's legal director, was the committee's last witness. Levy compli-mented Commissioners Geeslin and Betts on their leadership. He said both commissioners and the staff of the Division of Workers' Compensation have reached out to the Texas AFL-CIO seeking input on new rules and policies. Levy added that the Texas AFL-CIO looks forward to seeing how the workers' compensation networks work out and if the networks provide injured employees with adequate access to doctors.

An archived video of the January 12, 2006 public meeting of the Business & Industry Committee is available at http://www.house.state.tx.us/committees/broadcasts.php?session=79&cmte=040 under Interim Broadcasts.

Geoff Billings and Steve Nichols are with the Insurance Council of Texas and can be reached at snichols@insurancecouncil.org<.a> and gbillings@insurancecouncil.org

>-------------------------------

The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.