Here is a summary of legislative and regulatory developments and challenges for the first quarter of 2022 and their practical implications:
Texas WC Network Regulation: In January, the Texas Division of Workers’ Compensation proposed revisions to existing WCN regulations, explaining that changes were needed to clarify the provisions and to implement legislative amendments to the Insurance Code. These proposed changes are extensive and bear attention of WC system participants.
Among the prominent proposed provisions are the following:
- Location and service type identification requirements for WCN participating providers have been made much more specific.
- Networks must give prior notice to TDI of any proposed change of ownership.
- Networks must give prior notice to TDI regarding modifications to network configurations involving telehealth services.
- Network contracts and subcontracts with providers must include a statement that a carrier contesting compensability may not deny payment prior to the issuance of a notice that the injury was not compensable.
- Carriers and employers must have a documented procedure for determining which is responsible for obtaining signed employee acknowledgements of the employer’s network participation as well as signed copies of the employee acknowledgements.
- By September 23, 2022, networks must have a documented credentialing process that meets NCQA or URAC standards.
- Networks may only use Texas-licensed doctors to perform in-network utilization reviews.
Implications: Payers, certified WCNs and specialty networks should review their policies and procedures in preparation for TDI’s enforcement efforts based on these proposed regulations.
California MPN Legislation:
In January, a revised AB 399 was unanimously passed by the Assembly and sent to the Senate. In its current state, the measure requires payers to provide employees, within five business days of their request, with the MPN’s name and identification number. The payer may satisfy this requirement by providing the information in writing or an explanation of benefits or by posting the information on a website.
Implications: Through a concerted effort, the revised version of AB 399 now ensures employees are given timely and useful information. Without any discernable opposition, the measure is very likely to be enacted and signed into law.