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and negotiated heavily with a number of parties representing hospitals, insurers, and PPOs. Unfortunately, the legislation failed to pass. TMA believes the legislature should revisit and pass bills that address this deceptive practice.


Offer incentives to businesses that contract with the state or receive state economic development funds to provide employee health insurance


Texas needs to expand its efforts to address the problem of the uninsured. Whenever the state uses taxpayer funds to attract business, the business must be committed to offering existing and new Texas employees health insurance coverage.


The Texas Enterprise Fund (TEF) has been used to fund a variety of economic development projects around the state. Before funds are awarded, the governor, lieutenant governor, and speaker must agree that state funds can be used on a project.


According to the Governor’s Office, the TEF is used primarily to attract new business to the state or assist with the substantial expansion of an existing business as part of competitive recruitment.


To be eligible for TEF funds, a project undergoes a review process that considers many factors, including job creation and wages. Health insurance coverage should be added as one of the requirements these businesses must meet to be eligible for TEF funding.


Promote, preserve, and protect workers’ compensation gains


Texas employers pay the 12th-highest workers’ compensation premiums in the country, about 17 percent more than the national median.105


They


expect their employees’ work-related injuries to be treated appropriately and efficiently. Injured workers should be able to obtain clinically appropriate, cost-effective health care in a timely manner and within reasonable geographic proximity. Any system providing health care to injured workers should be clearly defined, fair,


60 TEXAS MEDICINE February 2013


simple to understand, accountable, and easily accessible by all parties involved.


The Texas workers’ compensation system has undergone significant changes since 2001 and more so since the passage of House Bill 7 in 2005. The Texas Department of Insurance’s Division of Workers’ Compensation (TDI-DWC) has taken steps to reduce and/or stabilize costs and improve injured employee outcomes (such as quality of care, access to care, and return-to-work outcomes), and minimize administrative complexities. These initiatives include the adoption of:


• Fair fee guidelines for professional services, inpatient and outpatient hospital services, and ambulatory surgical center services;


• Evidence-based treatment and return-to-work guidelines for non-network claims;


• Certification and monitoring of workers’ compensation health care networks;


• Rules and processes to streamline dispute resolution;


• Performance-based oversight, which assesses the performance of insurance carriers and health care professionals in meeting key regulatory goals; and


• Consensus-based stakeholder rulemaking procedures.


The 2010 sunset review of TDI-DWC contained many recommendations to further strengthen the agency’s ability to administer and enforce the system effectively. These recommendations, addressed in HB 2605 during the 2011 legislative session, cover such issues as dispute resolution, enforcement, the Medical Quality Review Panel, designated doctors, and nonsubscriber compliance with reporting requirements.


Require transparency in the insurance marketplace


Texans pay premiums with the expectation that they will receive a benefit that is worthwhile. Texas insurance companies design and sell insurance products that offer increased benefits when the insured person obtains medical or health


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