Are there any new requirements or changes regarding preauthorization of medical services and treatment? What are the changes?
A. Yes. HB 7 requires preauthorization for physical and occupational therapy in accordance with rules to be adopted by the Commissioner of Workers’ Compensation. (See Commissioner’s Bulletin No. B-0039-05A dated August 30, 2005.) However, workers’ compensation health care networks are not required to comply with Section 413.014, Labor Code, or Commissioner adopted rules relating to preauthorization, but may establish their own preauthorization requirements. Preauthorization cannot be required for emergency care. Health care that has been preauthorized is not subject to retrospective review for medical necessity. An employer must provide their employees a list of the health care services for which the insurance carrier or network requires preauthorization or concurrent review. Also see questions and answers in this FAQ on Compensability Disputes.
Related Questions
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