Texas Register, Volume 37, Number 30, Pages 5519-5676, July 27, 2012 Page: 5,553
5519-5676 p. ; 28 cm.View a full description of this periodical.
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week for 40 weeks duration during a given calendar year; or per-
formed administrative, leadership, or advisory roles in the prac-
tice of medicine. The medical advisor and the Commissioner
may waive these requirements if needed to adequately perform
medical case review.
Proposed new 180.62(e) provides that MQRP members shall
be appointed for a term of two years. They shall serve until the
expiration of their term, until their resignation, or until their re-
moval from the MQRP. An MQRP member may not serve on the
panel for more than 10 years. Years served prior to an appoint-
ment on or after September 1, 2013 do not count toward the
10-year limit. An MQRP member may resign from the MQRP at
any time. An MQRP member may be removed from the MQRP
for cause at any time on the order of the Commissioner for fail-
ure to maintain the eligibility requirements of this title, failure to
timely inform the Division of conflicts of interest, repeated fail-
ure to timely review medical case review assignments or timely
submit reports to the Division, repeated failure to prepare the re-
ports in the prescribed format; or other issues deemed sufficient
by the medical advisor or the commissioner.
Proposed new 180.62(f) provides that an MQRP member shall
not use his or her position to influence an insurance carrier,
agent, or other person or entity in connection with a personal
or other insurance related matter beyond referring to their posi-
tion to demonstrate qualifications except as otherwise provided
by this subchapter.
Proposed new 180.62(g) provides that the medical advisor shall
establish the Quality Assurance Panel (QAP) within the MQRP.
All members of the QAP are members of the MQRP. They per-
form all of the duties of an MQRP member under Labor Code
413.0512 as well as the duties of a QAP member under Labor
Code 413.05121. A member of the Quality Assurance Panel
(QAP) shall also be known as an Arbiter. An Arbiter is a person
empowered to judge and decide matters at issue. An Arbiter
serves in an informal settlement conference to help determine a
resolution of the case.
Arbiters may provide any services to the medical advisor pro-
vided by Labor Code 413.0512 and 413.05121, including, but
not limited to serving as a representative for the medical advi-
sor in informal settlement conferences, and serving as the chair
to the quality assurance committee. When the medical advisor
and associate medical advisor have both recused themselves
from a specific case, the Commissioner may appoint an Arbiter
to provide a final recommendation on enforcement action follow-
ing the investigation of a case through the medical quality review
process. Arbiters may serve as expert witnesses in enforcement
actions, as appropriate, and provide an additional level of medi-
cal expertise and quality assurance to assist the medical advisor
in the medical advisor's duties under Labor Code 413.0511.
Proposed New 180.64.
Proposed new 180.64(a) establishes the process to apply to be
a member of the MQRP. To apply to the MQRP, a person must
submit an application in the form and manner required by the
Division demonstrating compliance with the required qualifica-
tions. The application must contain the information required by
180.64(b). The medical advisor and the Commissioner may se-
lect and appoint only qualified applicants to the Division's MQRP
but are not required to accept all applicants who meet the re-
quirements specified in this subchapter.
Proposed new 180.64(b) establishes the contents of the appli-
cation form for the MQRP. The form must include, at a minimum,contact information for the health care practitioner, information
about the health care practitioner's education, a description of
the health care practitioner's license(s), certifications, and pro-
fessional specialty, if any, a description of the health care practi-
tioner's work history and hospital or other health care practitioner
affiliations.
The form must also contain a description of any affiliations the
health care practitioner has with a workers' compensation health
care network certified under Chapter 1305 of the Insurance
Code or a political subdivision as described in Labor Code
504.053(b)(2), identification of and a description of all current
and past review affiliations, including but not limited to an
independent review organization (IRO), utilization review agent
(URA), licensing board, and insurance carrier.
In addition, the form must include information regarding the
health care practitioner's current practice locations, disclosure
regarding the health care practitioner's professional back-
ground, education, training, and fitness to perform the duties
of an MQRP member. This must include disclosure of any
disciplinary actions or other sanctions taken against the health
care practitioner by any state licensing board, state or federal
agency, and hospital or other health care institution, as well as
disclosure of any voluntary relinquishments, drug and alcohol
misuse, malpractice claims history and criminal history.
The form must include a description of all ownership interests or
other financial arrangements, such as salaried or contract em-
ployment, involving a person or their agent subject to the Act or
a rule, order, or decision of the commissioner. A share of own-
ership is ownership as well as total ownership including shares
in ownership of facilities such as surgery centers.
The applicant must sign an authorization for third parties to re-
lease information relevant to the verification of the information
provided on the application to the Division, an affirmation that all
information provided in the application is accurate and complete
to the best of the health care practitioner's knowledge; and an
affirmation of understanding of the legal requirements, including
confidentiality provisions, for MQRP members.
Proposed new 180.64(c) provides that a credentialing applica-
tion for hospital credentialing may substitute for some items un-
der subsection (b).
Proposed new 180.64(d) provides that the health care practi-
tioner must inform the medical advisor of any changes to this
information within 30 days after the change.
Proposed new 180.64(e) provides that the application shall be
reviewed by the medical advisor.
Proposed new 180.64(f) provides that the medical advisor and
the Commissioner have the discretion to select and appoint an
applicant to the MQRP.
Proposed new 180.64(g) provides that membership in the
MQRP is for a term of two years. The acceptance letter will
include the effective date and expiration date.
Proposed new 180.64(h) provides that membership in the
MQRP is not a guarantee of any number of assignments.
Proposed new 180.64(i) provides that MQRP members are en-
titled to compensation for work assigned by the medical advisor
at the hourly rates specified in the rule. Doctors are entitled to
$150 per hour for medical case reviews, ad hoc work groups, or
special projects.PROPOSED RULES July 27, 2012 37 TexReg 5553
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Texas. Secretary of State. Texas Register, Volume 37, Number 30, Pages 5519-5676, July 27, 2012, periodical, July 27, 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth243959/m1/35/: accessed April 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.