reglab/housing_qa huggingface dataset:
TX Lab Code § 412.051 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 412 - State Office of Risk Management|Subchapter F. State Agencies|Section 412.051. Duties of State Agencies; Insurance Notification Requirements

Sec. 412.051.  DUTIES OF STATE AGENCIES; INSURANCE NOTIFICATION REQUIREMENTS.  (a)  Each state agency shall actively manage the risks of that agency by:(1)  developing, implementing, and maintaining programs designed to assist employees who sustain compensable injuries to return to work;  and(2)  cooperating with the office and the Texas Department of Insurance in the purchase of property, casualty, and liability lines of insurance coverage.(b)  Subject to Section 412.011, each state agency that intends to purchase property, casualty, or liability insurance coverage in a manner other than through the services provided by the office shall notify the office of the intended purchase in the manner prescribed by the office.  The state agency shall notify the office of the intended purchase not later than the 30th day before the date on which the purchase of the coverage is scheduled to occur.  The office may require a state agency to submit copies of insurance forms, policies, and other relevant information.|Added by Acts 1997, 75th Leg., ch. 1098, Sec. 1, eff. Sept. 1, 1997.  Amended by Acts 2001, 77th Leg., ch. 1017, Sec. 1.07, eff. Sept. 1, 2002.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1312 (S.B. 59), Sec. 81, eff. September 1, 2013.Acts 2013, 83rd Leg., R.S., Ch. 1312 (S.B. 59), Sec. 82, eff. September 1, 2013.|
TX Lab Code § 412.052 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 412 - State Office of Risk Management|Subchapter F. State Agencies|Section 412.052. Exemption of Certain State Agencies

Sec. 412.052.  EXEMPTION OF CERTAIN STATE AGENCIES.  This chapter does not apply to a state agency that had medical malpractice insurance coverage, workers' compensation insurance coverage, or other self-insurance coverage with associated risk management programs before January 1, 1989.|Added by Acts 1997, 75th Leg., ch. 1098, Sec. 1, eff. Sept. 1, 1997.|
TX Lab Code § 412.053 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 412 - State Office of Risk Management|Subchapter F. State Agencies|Section 412.053. Annual Report by State Agency

Sec. 412.053.  ANNUAL REPORT BY STATE AGENCY.  (a)  Each state agency shall report to the director for each fiscal year:(1)  the location, timing, frequency, severity, and aggregate amounts of losses by category of risk, including open and closed claims and final judgments;(2)  loss information obtained by the state agency in the course of its administration of the workers' compensation program;(3)  detailed information on existing and potential exposure to loss, including property location and values, descriptions of agency operations, and estimates of maximum probable and maximum possible losses by category of risk;(4)  estimates by category of risk of losses incurred but not reported;(5)  information the director determines necessary to prepare a Texas Workers' Compensation Unit Statistical Report;  and(6)  additional information that the director determines to be necessary.(b)  The information shall be reported not later than the 60th day after the last day of each fiscal year.(c)  This section does not apply to an institution of higher education or university system.  In this subsection, "institution of higher education" and "university system" have the meanings assigned by Section 61.003, Education Code.|Added by Acts 1997, 75th Leg., ch. 1098, Sec. 1, eff. Sept. 1, 1997.  Amended by Acts 2001, 77th Leg., ch. 1017, Sec. 1.08, eff. Sept. 1, 2002.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1049 (S.B. 5), Sec. 6.13, eff. June 17, 2011.Acts 2019, 86th Leg., R.S., Ch. 19 (S.B. 612), Sec. 4, eff. September 1, 2019.Acts 2019, 86th Leg., R.S., Ch. 573 (S.B. 241), Sec. 1.40, eff. September 1, 2019.|
TX Lab Code § 412.054 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 412 - State Office of Risk Management|Subchapter F. State Agencies|Section 412.054. Continuity of Operations Plan

Sec. 412.054.  CONTINUITY OF OPERATIONS PLAN.  (a)  Each state agency shall work with the office to develop an agency-level continuity of operations plan that outlines procedures to keep the agency operational in case of disruptions to production, finance, administration, or other essential operations.  The plan must include detailed information regarding resumption of essential services after a catastrophe, including:(1)  coordination with public authorities;(2)  management of media;(3)  customer service delivery;(4)  assessing immediate financial and operational needs; and(5)  other services as determined by the office.(b)  A continuity of operations plan that meets the requirements of this section must be submitted by each state agency that is:(1)  involved in the delivery of emergency services as a member of the governor's Emergency Management Council;(2)  part of the State Data Center program; or(3)  subject to this chapter or Chapter 501.(c)  Except as otherwise provided by this section, the following information is confidential and is exempt from disclosure under Chapter 552, Government Code:(1)  a continuity of operations plan developed under this section; and(2)  any records written, produced, collected, assembled, or maintained as part of the development or review of a continuity of operations plan under this section.(d)  Forms, standards, and other instructional, informational, or planning materials adopted by the office to provide guidance or assistance to a state agency in developing a continuity of operations plan under this section are public information subject to disclosure under Chapter 552, Government Code.(e)  A state agency may disclose or make available information that is confidential under this section to another state agency, a governmental body, or a federal agency.(f)  Disclosing information to another state agency, a governmental body, or a federal agency under this section does not waive or affect the confidentiality of that information.|Added by Acts 2007, 80th Leg., R.S., Ch. 407 (S.B. 908), Sec. 11, eff. September 1, 2007.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1045 (H.B. 1832), Sec. 4, eff. June 19, 2015.|
TX Lab Code § 413.002 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter A. General Provisions|Section 413.002. Medical Review

Sec. 413.002.  MEDICAL REVIEW.  (a)   The division shall monitor health care providers, insurance carriers, independent review organizations, and workers' compensation claimants who receive medical services to ensure the compliance of those persons with rules adopted by the commissioner relating to health care, including medical policies and fee guidelines.(b)  In monitoring health care providers who serve as designated doctors under Chapter 408 and independent review organizations who provide services described by this chapter, the division shall evaluate:(1)  compliance with this subtitle and with rules adopted by the commissioner relating to medical policies, fee guidelines, treatment guidelines, return-to-work guidelines, and impairment ratings; and(2)  the quality and timeliness of decisions made under Section 408.0041, 408.122, 408.151, or 413.031.(c)  The division shall report the results of the monitoring of independent review organizations under Subsection (b) to the department on at least a quarterly basis.(d)  If the commissioner determines that an independent review organization is in violation of this chapter, rules adopted by the commissioner under this chapter, applicable provisions of this code or rules adopted under this code, or applicable provisions of the Insurance Code or rules adopted under that code, the commissioner or a designated representative shall notify the independent review organization of the alleged violation and may compel the production of any documents or other information as necessary to determine whether the violation occurred.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.42, eff. Sept. 1, 1995.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.227, eff. September 1, 2005.|
TX Lab Code § 413.003 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter A. General Provisions|Section 413.003. Authority to Contract

Sec. 413.003.  AUTHORITY TO CONTRACT.  The division may contract with a private or public entity to perform a duty or function of the division.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.228, eff. September 1, 2005.|
TX Lab Code § 413.004 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter A. General Provisions|Section 413.004. Coordination With Providers

Sec. 413.004.  COORDINATION WITH PROVIDERS.  The division shall coordinate its activities with health care providers as necessary to perform its duties under this chapter.  The coordination may include:(1)  conducting educational seminars on commissioner rules and procedures; or(2)  providing information to and requesting assistance from professional peer review organizations.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.229, eff. September 1, 2005.|
TX Lab Code § 413.006 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter A. General Provisions|Section 413.006. Advisory Committees

Sec. 413.006.  ADVISORY COMMITTEES.  The commissioner may appoint advisory committees as the commissioner considers necessary.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.230, eff. September 1, 2005.|
TX Lab Code § 413.007 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter A. General Provisions|Section 413.007. Information Maintained by Division

Sec. 413.007.  INFORMATION MAINTAINED BY DIVISION.  (a)  The division shall maintain a statewide data base of medical charges, actual payments, and treatment protocols that may be used by:(1)  the commissioner in adopting the medical policies and fee guidelines; and(2)  the division in administering the medical policies, fee guidelines, or rules.(b)  The division shall ensure that the data base:(1)  contains information necessary to detect practices and patterns in medical charges, actual payments, and treatment protocols;  and(2)  can be used in a meaningful way to allow the commission to control medical costs as provided by this subtitle.(c)  The division shall ensure that the data base is available for public access for a reasonable fee established by the commissioner.  The identities of injured workers and beneficiaries may not be disclosed.(d)  The division shall take appropriate action to be aware of and to maintain the most current information on developments in the treatment and cure of injuries and diseases common in workers' compensation cases.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.231, eff. September 1, 2005.|
TX Lab Code § 413.008 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter A. General Provisions|Section 413.008. Information From Insurance Carriers; Administrative Violation

Sec. 413.008.  INFORMATION FROM INSURANCE CARRIERS; ADMINISTRATIVE VIOLATION.  (a)  On request from the division for specific information, an insurance carrier shall provide to the division any information in the carrier's possession, custody, or control that reasonably relates to the division's duties under this subtitle and to health care:(1)  treatment;(2)  services;(3)  fees; and(4)  charges.(b)  The division shall keep confidential information that is confidential by law.(c)  An insurance carrier commits an administrative violation if the insurance carrier fails or refuses to comply with a request or violates a rule adopted to implement this section. |Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.232, eff. September 1, 2005.|
TX Lab Code § 413.0111 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.0111. Processing Agents

Sec. 413.0111.  PROCESSING AGENTS.  The rules adopted by the commissioner for the reimbursement of prescription medications and services must authorize pharmacies to use agents or assignees to process claims and act on the behalf of the pharmacies under terms and conditions agreed on by the pharmacies.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.234, eff. September 1, 2005.|
TX Lab Code § 413.0112 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.0112. Reimbursement of Federal Military Treatment Facility

Sec. 413.0112.  REIMBURSEMENT OF FEDERAL MILITARY TREATMENT FACILITY.  (a)  In this section, "federal military treatment facility" means a medical facility that operates as part of the Military Health System of the United States Department of Defense.(b)  The reimbursement rates for medical services provided to an injured employee by a federal military treatment facility must be the amount charged by the facility as determined under 32 C.F.R. Part 220.(c)  Chapter 1305, Insurance Code, and the following sections of this code do not apply to the reimbursement of a federal military treatment facility's charges for medical services provided to an injured employee:(1)  Sections 408.027(a) and (f);(2)  Section 408.0271;(3)  Section 408.0272;(4)  Section 408.028;(5)  Section 408.0281;(6)  Section 413.011;(7)  Section 413.014;(8)  Section 413.031, as that section relates to medical fee disputes;(9)  Section 413.041; and(10)  Section 504.053.(d)  The commissioner shall adopt rules necessary to implement this section, including rules establishing:(1)  requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility; and(2)  a separate medical dispute resolution process to resolve disputes over charges billed directly to an injured employee by a federal military treatment facility.|Added by Acts 2019, 86th Leg., R.S., Ch. 427 (S.B. 935), Sec. 1, eff. September 1, 2019.|
TX Lab Code § 413.0115 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.0115. Requirements for Certain Voluntary or Informal Networks

Sec. 413.0115.  REQUIREMENTS FOR CERTAIN VOLUNTARY OR INFORMAL NETWORKS.  (a)  In this section:(1)  "Informal network" means a health care provider network described by Section 413.011(d-1) that:(A)  is established under a contract between an insurance carrier and health care providers; and(B)  includes a specific fee schedule.(2)  "Voluntary network" means a voluntary workers' compensation health care delivery network established by an insurance carrier under former Section 408.0223, as that section existed before repeal by Chapter 265, Acts of the 79th Legislature, Regular Session, 2005.(b)  Not later than January 1, 2011, each informal network or voluntary network must be certified as a workers' compensation health care network under Chapter 1305, Insurance Code.(c)  Effective September 1, 2007, each informal network and voluntary network must provide the following information to the division:(1)  an executive contact for official correspondence for the network;(2)  a toll-free telephone number by which a health care provider may contact the informal network or voluntary network;(3)  a list of each insurance carrier with whom the network contracts; and(4)  a list of each entity associated with the network working on behalf of the insurance carrier, including contact information for each entity.(d)  Each informal network and voluntary network shall report any changes to the information provided under Subsection (c) to the division not later than the 30th day after the effective date of the change.|Added by Acts 2007, 80th Leg., R.S., Ch. 1177 (H.B. 473), Sec. 3, eff. September 1, 2007.|
TX Lab Code § 413.012 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.012. Medical Policy and Guideline Updates Required

Sec. 413.012.  MEDICAL POLICY AND GUIDELINE UPDATES REQUIRED.  The medical policies and fee guidelines shall be reviewed and revised at least every two years to reflect fair and reasonable fees and to reflect medical treatment or ranges of treatment that are reasonable or necessary at the time the review and revision is conducted.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.|
TX Lab Code § 413.013 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.013. Programs

Sec. 413.013.  PROGRAMS.  The commissioner by rule shall establish:(1)  a program for prospective, concurrent, and retrospective review and resolution of a dispute regarding health care treatments and services;(2)  a program for the systematic monitoring of the necessity of treatments administered and fees charged and paid for medical treatments or services, including the authorization of prospective, concurrent, or retrospective review under the medical policies of the division to ensure that the medical policies or guidelines are not exceeded;(3)  a program to detect practices and patterns by insurance carriers in unreasonably denying authorization of payment for medical services requested or performed if authorization is required by the medical policies of the division; and(4)  a program to increase the intensity of review for compliance with the medical policies or fee guidelines for any health care provider that has established a practice or pattern in charges and treatments inconsistent with the medical policies and fee guidelines.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.235, eff. September 1, 2005.|
TX Lab Code § 413.0141 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.0141. Initial Pharmaceutical Coverage

Sec. 413.0141.  INITIAL PHARMACEUTICAL COVERAGE.  The commissioner may by rule provide that an insurance carrier shall provide for payment of specified pharmaceutical services sufficient for the first seven days following the date of injury if the health care provider requests and receives verification of insurance coverage and a verbal confirmation of an injury from the employer or from the insurance carrier as provided by Section 413.014.  The rules adopted by the commissioner shall provide that an insurance carrier is eligible for reimbursement for pharmaceutical services paid under this section from the subsequent injury fund in the event the injury is determined not to be compensable.|Added by Acts 2001, 77th Leg., ch. 1456, Sec. 4.03, eff. June 17, 2001.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.237, eff. September 1, 2005.|
TX Lab Code § 413.015 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.015. Payment by Insurance Carriers; Audit and Review

Sec. 413.015.  PAYMENT BY INSURANCE CARRIERS;  AUDIT AND REVIEW.  (a)  Insurance carriers shall make appropriate payment of charges for medical services provided under this subtitle.  An insurance carrier may contract with a separate entity to forward payments for medical services.  Any payment due the insurance carrier from the separate entity must be made in accordance with the contract.  The separate entity is subject to the direction of the insurance carrier, and the insurance carrier is responsible for the actions of the separate entity under this subsection.(b)  The commissioner shall provide by rule for the review and audit of the payment by insurance carriers of charges for medical services provided under this subtitle to ensure compliance of health care providers and insurance carriers with the medical policies and fee guidelines adopted by the commissioner.(c)  The rules must require the insurance carrier to pay the expenses of the review and audit.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.03, eff. June 17, 2001.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.238, eff. September 1, 2005.|
TX Lab Code § 413.016 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.016. Payments in Violation of Medical Policies and Fee Guidelines

Sec. 413.016.  PAYMENTS IN VIOLATION OF MEDICAL POLICIES AND FEE GUIDELINES.  (a)  The division shall order a refund of charges paid to a health care provider in excess of those allowed by the medical policies or fee guidelines.  The division shall also refer the health care provider alleged to have violated this subtitle to the division of compliance and practices.(b)  If the division determines that an insurance carrier has paid medical charges that are inconsistent with the medical policies or fee guidelines adopted by the commissioner, the division shall investigate the potential violation.  If the insurance carrier reduced a charge of a health care provider that was within the guidelines, the insurance carrier shall be directed to submit the difference to the provider unless the reduction is in accordance with an agreement between the health care provider and the insurance carrier.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.239, eff. September 1, 2005.|
TX Lab Code § 413.017 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter B. Medical Services and Fees|Section 413.017. Presumption of Reasonableness

Sec. 413.017.  PRESUMPTION OF REASONABLENESS.  The following medical services are presumed reasonable:(1)  medical services consistent with the medical policies and fee guidelines adopted by the commissioner; and(2)  medical services that are provided subject to prospective, concurrent, or retrospective review as required by the medical policies of the division and that are authorized by an insurance carrier.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.240, eff. September 1, 2005.|