Practice Pointer: Federal Military Treatment Facility Bill Processing
In 2019, the legislature passed SB 935 by Sen. Hancock, which concerns the obligation of a workers’ compensation carrier to pay bills from medical facilities that operate as part of the Military Health System of the United States Department of Defense. One example is Brooke Army Medical Center.
The Division passed rules to implement the changes made in the legislation in December 2019. Those rules included requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility; and a separate medical dispute resolution process to resolve disputes over charges billed directly to an injured employee by a federal military treatment facility.
The rules also establish requirements for processing medical bills for services provided to an injured employee by a federal military treatment facility (FMTF), as well as a separate medical dispute resolution process designed to address disputes over charges billed by FMTFs. The change in law made by SB 935 applies to health care services provided to an injured employee on or after January 1, 2020, regardless of the date of injury.
Rule 134.150. Reimbursement of Services Provided by a Federal Military Treatment Facility
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- Establishes applicability of rules in subsections (a)-(b).
- Clarifies bill processing requirements in subsection (c)-(d).
- Clarifies that an insurance carrier may only deny a medical bill based on medical necessity, compensability, extent of injury, or liability in subsection (e).
- Requires carriers to REPORT the first bill received from an FMTF to DWC.
- Clarifies that unreported bills are subject to a request for information under Rule 102.9 in subsection (g).
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Rule 134.155. Federal Military Treatment Facility Disputes
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- Provides that disputes for medical necessity will be adjudicated under Rule 133.308, except that an injured employee may initiate a dispute, may request reconsideration, and the insurance carrier will be responsible for all independent review organization fees in subsection (a)(1).
- Provides that all other disputes will be handled under the existing process for benefit review conferences in subsection (a)(2).
- Notes that a first responder may request expedited dispute resolution in subsection (c).
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As required under Rule 134.150 (f), insurance carriers are required to report the first bill received from an FMTF to DWC. Instructions about where to submit the first bill can be found on the Division’s website. That page also contains DWC answers to FAQs and links to the applicable statutory provisions and rule.
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