For the attorneys that follow this blog, in a decision that should surprise no one, the Texas Supreme Court refused to review the decision in Texas Mutual Insurance Co. vs. Vista Community Medical Center, LLP. Practitioners will recall that this is the Austin Court of Appeals decision from 2008 that invalidated the stop-loss exception.
Hospitals that treat workers' compensation patients in Texas are reimbursed under the state's workers' compensation in-patient fee schedule.The 1997 fee schedule, which was repealed in 2008, included a stop-loss exception. Under the stop-loss exception, hospitals could be paid more than the fee schedule if they met certain criteria. The dispute between Texas Mutual and Vista centered on those criteria. Texas Mutual argued that the stop-loss exception should be applied to admissions involving charges of more than $40,000 and "unusually extensive services." Vista countered that the exception applied to all admissions for which they charged more than $40,000.
The stop-loss rule has since been repealed. However, many fee disputes remained outstanding under the old rule.