Is TWCC Headed Back to the Fee Guideline Drawing Board’

The new medical fee guideline approved by the Texas Workers’ Compensation Commission (TWCC) last spring that was scheduled to go into effect Sept. 1 was recently stayed by a Travis County judge as part of a lawsuit filed against TWCC by groups opposing the new fee schedule. Since then both supporters of the plan and its opponents have been busy contemplating the next move in the effort to hold down workers’ comp costs in Texas.

The fee guidelines were adopted as part of TWCC’s efforts to that end and would have cut reimbursements by as much as 15 percent to certain doctors for various medical procedures. However, the Texas Medical Association (TMA) and the Texas AFL-CIO jointly filed a lawsuit against the TWCC in July alleging that that TWCC violated the law in basing the fee structure on Medicare reimbursement guidelines. The Austin American-Statesman reported that in halting implementation of the fee schedule, Judge John Dietz ruled that the commission had failed to justify the guidelines.

In July TMA asserted that the fee schedule violates doctors’ legal right to reasonable reimbursement and would force doctors out of the system. In addition to their allegations that the fee schedule was illegally tied workers’ comp reimbursement to the fees that Medicare pays for similar medical services to elderly Texans, TMA and the AFL-CIO claimed that TWCC did not develop enough data to be able to set fees that accurately reflect the cost of providing health care. The TMA also alleged that the guidelines cut reimbursements by 17 to 41 percent for surgeons, radiologists, pathologists, internists, and physical medicine specialists who treat injured workers.

TWCC, which was charged by the legislature to develop the fee schedule under House Bill 2600, the workers’ compensation legislation passed by the 77th Texas Legislature, had counted on the implementation of the guidelines. Richard F. (Dick) Reynolds, executive director of the Texas Workers Compensation Commission (TWCC), told insurers at the 2002 Mid-Year Property & Casualty Insurance Symposium held in Austin in July that the medical fee guideline was the most important element of that legislation. “This particular article-the medical fee guideline-in HB 2600 is paramount,” Reynolds said, adding, “if it goes down, to me, we’ve got to start all over.”

He urged insurers help fight legal challenges to the guidelines.

Asked whether TWCC would appeal Judge Dietz’s ruling, TWCC spokesperson Linda McKee said the agency has received “no copy of the judge’s order yet, so there has not been a decision made.”

Editor’s note: To see the full story, please see the Sept. 2 issue of Insurance Journal Texas/ South Central, beginning on Page 8.

Topics Texas Workers' Compensation