April 20, 2018

Texas DOI Issues Informal Proposal Regarding the Amendment of 28 TAC §134.503

Austin, TX., October 25, 2010–WorkCompWire–The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting
comment on two drafts of an informally proposed rule to amend 28 Texas Administrative Code (TAC)
§134.503 regarding the Pharmacy Fee Guideline. The informal proposal rule drafts were posted on
October 25, 2010 and may be viewed at http://www.tdi.state.tx.us/wc/rules/drafts.html. The comment
period on the informal proposal closes Monday, November 15, 2010 at 5 p.m. [Central Standard Time

The purpose of the rule is to implement statutory amendments to Texas Labor Code §408.028 and
§413.011 under House Bill 7, enacted by the 79th Legislature, Regular Session (effective September
1, 2005) and House Bill 473, enacted by the 80th Legislature, Regular Session (effective September
1, 2007). The informal drafts update the rule to conform to requirements in the Texas Labor Code
and clarify the applicability of the pharmacy fee guideline.

On May 20, 2010, TDI-DWC submitted a request for an opinion to the Office of the Attorney General
regarding “the authority of workers’ compensation insurance carriers to pay for a prescription drug,
medicine, or other remedy at a lower fee rate than the fee rates allowed under the Texas Department
of Insurance, Division of Workers’ Compensation’s fee guidelines after January 1, 2011”. A copy of
the request (RQ-0890-GA) is available at

TDI-DWC requests workers’ compensation system participants’ input on both Draft A and Draft B
informal working draft rules. Both of these rule drafts are dependent on the outcome of the Office of
the Attorney General’s opinion. TDI-DWC contracted with Milliman for professional actuarial services
to assist in developing the revised fee formula in Draft B. The Milliman Report, which is the basis for
the calculation of the revised fee formula, is available at

TDI-DWC is anticipating an emergency rule adoption due to the short time frame available to adopt a
Pharmacy Fee Guideline rule and have it become effective by January 1, 2011.

These informal working drafts are not a formal rule proposal. Accordingly, comments will not be
treated as formal public comment for the purposes of the Administrative Procedure Act. The informal
working drafts contain drafting notes and formatting which will be changed as necessary to comply
with the Texas Register formatting.

Informal comments may be submitted by e-mailing InformalRuleComments@tdi.state.tx.us or by
mailing or delivering the informal comments to Maria Jimenez at:

Texas Department of Insurance, Division of Workers’ Compensation
Workers’ Comp Counsel MS – 4D
7551 Metro Center Drive, Suite 100
Austin, Texas 78744 -1645

An informational hearing for system participants on these informal proposals will be held on Tuesday,
November 16, 2010 at 9 a.m. CST in the Tippy Foster Room of the TDI-DWC Central Office, 7551
Metro Center Drive, Suite 100 in Austin.

If there are any questions regarding the information in this memo, contact Elena Cablao at (512) 804-
4748 or Elena.Cablao@tdi.state.tx.us.

Source: Texas DOI-DWC

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