Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 10 - WORKERS' COMPENSATION HEALTH CARE NETWORKS
Subchapter A - GENERAL PROVISIONS AND DEFINITIONS
Section 10.1 - Purpose and Scope

Universal Citation: 28 TX Admin Code § 10.1

Current through Reg. 50, No. 13; March 28, 2025

(a) This chapter implements provisions of the Workers' Compensation Health Care Network Act, Insurance Code Chapter 1305, concerning Workers' Compensation Health Care Networks, and provides standards for the certification, administration, evaluation, and enforcement of the delivery of health care services to injured employees by networks contracting with or established by:

(1) workers' compensation insurance carriers;

(2) employers certified to self-insure under Labor Code Chapter 407, concerning Self-Insurance Regulation;

(3) groups of employers certified to self-insure under Labor Code Chapter 407A, concerning Group Self-Insurance Coverage; and

(4) except as described in subsection (d) of this section, governmental entities that self-insure, either individually or collectively, under:
(A) Labor Code Chapter 501, concerning Workers' Compensation Insurance Coverage for State Employees, Including Employees Under the Direction or Control of the Board of Regents of Texas Tech University;

(B) Labor Code Chapter 502, concerning Workers' Compensation Insurance Coverage for Employees of the Texas A&M University System and Employees of Institutions of the Texas A&M University System;

(C) Labor Code Chapter 503, concerning Workers' Compensation Insurance Coverage for Employees of the University of Texas System and Employees of Institutions of the University of Texas System;

(D) Labor Code Chapter 504, concerning Workers' Compensation Insurance Coverage for Employees of Political Subdivisions; and

(E) Labor Code Chapter 505, concerning Workers' Compensation Insurance Coverage for Employees of Texas Department of Transportation.

(b) This chapter applies to:

(1) each person who performs a function or service of a workers' compensation health care network as defined by § 10.2 of this title (relating to Definitions), including a person who performs a function or service delegated by or through a workers' compensation health care network; and

(2) an insurance carrier as defined by Labor Code § 401.011, concerning General Definitions, that establishes or contracts with a workers' compensation health care network.

(c) A person that performs the functions of an administrator for an insurance carrier under Insurance Code Chapter 1305 must hold a certificate of authority under Insurance Code Chapter 4151, concerning Third-Party Administrators.

(d) This chapter does not apply to health care services provided to injured employees of a self-insured political subdivision or injured employees of the members of a pool established under Government Code Chapter 791, concerning Interlocal Cooperation Contracts, if the political subdivision or pool elects to provide health care services to its injured employees in the manner authorized under Labor Code § 504.053(b)(2), concerning Workers' Compensation Insurance Coverage for Employees of Political Subdivisions.

(e) This chapter does not authorize a workers' compensation insurance policyholder, including a policyholder who purchases a deductible plan under Insurance Code Chapter 2053, Subchapter E, concerning Optional Deductible Plans, to contract directly with a workers' compensation health care network for the provision of health care services to injured employees.

(f) If a court of competent jurisdiction holds that any provision of this chapter is inconsistent with any statutes of this state, is unconstitutional, or is invalid for any reason, the remaining provisions of this chapter remain in full effect.

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