TWCC Recommends Provider Networks in Report to Legislature

The Texas Workers’ Compensation Commission has submitted its recommended changes to the Texas Workers’ Compensation Act to be considered by the 79th Texas Legislature beginning in January 2005. The recommendations were delivered to Gov. Rick Perry, Lt. Gov. David Dewhurst and Speaker Tom Craddick, as well as to the chairmen of legislative committees handling workers’ compensation issues, on Nov. 22, 2004.

“This report summarizes changes needed in the law relating to the delivery of workers’ compensation benefits,” said Commission Chairman Mike Hachtman, in announcing the report. “These changes will improve treatment for injured workers and get them back to work sooner.

“We also have made recommendations to streamline the dispute resolution processes and reduce the ‘hassles’ of the system to all participants,” Hachtman said. “These changes will ultimately lower costs.”

Recognizing that the cost of health care in Texas’ current workers’ comp system is much higher than in most other states, under the general heading of Medical Cost Containment the Commission recommended the creation of health care networks to treat injured workers.

The report explained that while a pilot program using networks could be established under the current statute, “the pilot networks contemplated by the statute are not feasible because injured workers have freedom of choice of doctor/provider and cannot be required to utilize a network provider.”

TWCC said costs could be controlled more effectively by establishing provider networks within the workers’ comp system and requiring “injured workers to select a provider from the network.” The recommendation includes allowing “carriers issuing workers’ compensation policies to utilize a network of providers for the delivery of timely, reasonable, and necessary medical care to injured workers. Carriers may form their own networks or contract with existing networks.”

Addressing the problem of return to work, or lack of it, TWCC advocated establishing a “Functional Restoration and Return to Work process” that would “help control medical costs and indemnity costs, reduce lost time away from work, and improve return-to-work outcomes.”

Other recommendations in the report are listed in sections titled Fraud, Increased Protection for Claimants/Injured Workers, Reduced Regulatory Responsibilities for Employers, Clarifications and Miscellaneous. The report is available online at www.twcc.state.tx.us/commission/79th_leg_recs.pdf.