Texas Register, Volume 36, Number 44, Pages 7417-7610, November 4, 2011 Page: 7,571
7417-7610 p. ; 28 cm.View a full description of this periodical.
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Agency Response: The Division agrees that future amendments to
133.2 may be required to update this chapter. The amendment or
repeal of 133.2 is a policy decision which would require analysis
and formal rulemaking, including notice and an opportunity for fur-
ther stakeholder input. These suggestions may have merit and will be
retained and used in future analysis and rulemaking efforts under the
Government Code.
Comment: Commenter states that 133.4 and 133.5 should be re-
pealed since Labor Code 413.011 expired January 1, 2011.
Agency Response: The Division agrees that 133.4 and 133.5 expired
as of January 1, 2011, and declines to readopt those sections at this time.
The Division will consider the repeal of those sections at a future date.
Any repeal of those sections will be accomplished in accordance with
rulemaking under the Administrative Procedure Act.
Comment: Commenter states that 133.210 includes a reference to Di-
vision rules in 133.210(c)(4) that needs to be updated.
Agency Response: The Division agrees that future amendments to
133.210 may be required to update this chapter. The amendment
of 133.210(c)(4) is a policy decision which would require analysis
and formal rulemaking, including notice and an opportunity for further
stakeholder input before any amendment. These suggestions may have
merit and will be retained and used in future analysis and rulemaking
efforts under the Government Code.
Comment: This Commenter states that 133.240 should be updated
or clarified as a result of amendments to the Insurance Code Chapter
4201, which affect Utilization Review Agents and Independent Review
Organizations.
Agency Response: 133.240 is proposed for rulemaking. The pro-
posed rule amendments are contained in the July 29, 2011, issue of the
Texas Register (36 TexReg 4774). The comment period for amend-
ments to 133.240 ended 5:00 p.m., CST, on September 27, 2011.
Comment: Commenter states the Division may need to update
133.306 to include the adoption of a pharmacy closed formulary rule.
Agency Response: The Division disagrees that 133.306 needs updat-
ing since adoption of the closed formulary. Amended 133.306 was
adopted on December 17, 2010 and becomes effective September 1,
2011. The adoption was published in the December 17, 2010, issue of
the Texas Register (35 TexReg 11344). The adopted amendments have
provisions that incorporate the pharmacy closed formulary.
Comment: Commenter states that 133.308 should be updated or clar-
ified as a result of amendments to the Insurance Code Chapter 4201,
which affect Utilization Review Agents and Independent Review Or-
ganizations.
Agency Response: The Division agrees that future amendments to
133.308 may be required to update this chapter. The amendment or
repeal of 133.308 is a policy decision which would require analysis
and formal rulemaking, including notice and an opportunity for fur-
ther stakeholder input. These suggestions may have merit and will be
retained and used in future analysis and rulemaking efforts under the
Government Code.
The Division has determined that the reasons for adopting the following
sections continue to exist and the sections are retained in their present
form. However, if revisions are determined to be needed based on
further analysis, those revisions will be accomplished in accordance
with the Administrative Procedure Act.
Subchapter A - General Rules for Medical Billing and Processing
133.1. Applicability of Medical Billing and Processing.133.2. Definitions.
133.3. Communication Between Health Care Providers and Insurance
Carriers.
Subchapter B - Health Care Provider Billing Procedures
133.10. Required Billing Forms/Formats.
133.20. Medical Bill Submission by Health Care Provider.
Subchapter C - Medical Bill Processing/Audit by Insurance Carrier
133.200. Insurance Carrier Receipt of Medical Bills from Health Care
Providers.
133.210. Medical Documentation.
133.230. Insurance Carrier Audit of a Medical Bill.
133.240. Medical Payments and Denials.
133.250. Reconsideration for Payment of Medical Bills.
133.260. Refunds.
133.270. Injured Employee Reimbursement for Health Care Paid.
133.280. Employer Reimbursement for Health Care Paid.
Subchapter D - Dispute of Medical Bills
133.305. MDR - General.
133.307. MDR of Fee Disputes.
133.308. MDR by Independent Review Organizations.
Subchapter G - Electronic Medical Billing, Reimbursement, and Doc-
umentation
133.500. Electronic Formats for Electronic Medical Bill Processing.
133.501. Electronic Medical Bill Processing.
133.502. Electronic Medical Billing Supplemental Requirements.
During the rule review of Chapter 133 conducted by the Division,
133.2, 133.240, 133.250, 133.270, and 133.305 were proposed for
rulemaking. That rulemaking is a separate and distinct process from the
rule review process. The proposed amendments for those sections are
contained in the July 29, 2011, issue of the Texas Register (36 TexReg
4774). The comment period for amendments to 133.2, 133.240,
133.250, 133.270, and 133.305 ended 5:00 p.m., CST, on September
27, 2011. Those sections are readopted as they exist on the date of sub-
mission to the Texas Register.
As noted above, amendments to 133.306 were adopted on Decem-
ber 17, 2010 and became effective September 1, 2011. The adoption
was published in the December 17, 2010, issue of the Texas Register
(35 TexReg 11344). The Division has determined that the reasons for
adopting 133.306 continue to exist, and readopts that section as it ex-
ists on the date of submission to the Texas Register.
Subchapter D - Dispute of Medical Bills
133.306. Interlocutor Orders for Medical Benefits.
As a result of the review, the Division has determined that the reason
for adoption of 133.309 does not continue to exist due to this section
being declared invalid by judicial review. A Texas Appellate Court
has held that this section was in conflict with statutes governing judi-
cial review of medical fee disputes, and therefore this section is not
readopted. This section will be amended or repealed at a later date in
accordance with the Administrative Procedure Act.
Subchapter D - Dispute of Medical BillsRULE REVIEW November 4, 2011 36 TexReg 7571
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Texas. Secretary of State. Texas Register, Volume 36, Number 44, Pages 7417-7610, November 4, 2011, periodical, November 4, 2011; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth193249/m1/150/: accessed April 28, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.