TDI Adopts New IRO Rules

The Texas Department of Insurance has adopted new rules governing Independent Review Organizations. The effective date of the new rules is July 7, 2015. Among the changes found in the 139 page rule adoption order is a change in the payment deadline to pay the IRO. An amendment to Rule 12.404(c) changes the number of days within which URAs or payors must pay IROs from 30 to 15. These amendments implement Insurance Code §4202.002(a). TDI states that the amendment is necessary because TDI has determined 15 days is a sufficient amount of time for URAs or payors to pay IROs.

In one of the more controversial issues related to the rule adoption, the Department declined to adjust IRO fees. Currently, Rule 12.403 provides that tier one fees are $650.00 and tier two fees are $460.00. IROs argued during the rule making process that they were entitled to an increase in fees, which had not been adjusted since 1997. Other system stakeholders argued that IRO fees in Texas are higher than in other comparable states and that the fees should be reduced. The agency left the fees as they currently exist, writing that it had “sought but did not receive specific information about the current market value of performing independent reviews, and determined that the current fee amounts reflect, in general, the current market value of these services when compared to other states.”

All carriers should confirm that their URAs are sufficiently familiar with the new rules and that they are prepared to implement the changes found in the rule adoption order prior to the July 7, 2015 effective date.

UPDATE: Rule 133.308 provides for a 15-day deadline to pay the IRO fee in workers’ compensation disputes. The amendment of Rule 12.404(c) makes the non-workers’ compensation deadline consistent with the deadline in workers’ compensation cases.