Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 10 - WORKERS' COMPENSATION HEALTH CARE NETWORKS
Subchapter E - NETWORK OPERATIONS
Section 10.83 - Guidelines and Protocols
Current through Reg. 50, No. 13; March 28, 2025
(a) Each network must adopt treatment guidelines, return-to-work guidelines, and individual treatment protocols, which must be evidence-based, scientifically valid, outcome-focused, and be designed to reduce inappropriate or unnecessary health care while safeguarding access to necessary care.
(b) An insurance carrier or network may not deny treatment for a compensable injury solely because its treatment guidelines do not specifically address the treatment or injury.
(c) A network must, through its quality improvement program under § 10.81 of this title (relating to Quality Improvement Program), assure that all treatment guidelines, return-to-work guidelines, and individual treatment protocols are made accessible to all network providers. The network must contractually require providers to follow treatment guidelines, return-to-work guidelines, and individual treatment protocols pursuant to § 10.42(b)(2) of this title (relating to Network Contracts with Providers).
