Texas Register, Volume 37, Number 30, Pages 5519-5676, July 27, 2012 Page: 5,552
This periodical is part of the collection entitled: Texas Register and was provided to The Portal to Texas History by the UNT Libraries Government Documents Department.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
CHAPTER 180. MONITORING AND
ENFORCEMENT
SUBCHAPTER C. MEDICAL QUALITY
REVIEW PANEL
28 TAC 180.60, 180.62, 180.64, 180.66, 180.68, 180.70,
180.72, 180.74, 180.76, 180.78
The Texas Department of Insurance (Department), Division of
Workers' Compensation (Division) proposes new Subchapter
C, Medical Quality Review Panel (MQRP), 180.60, concerning
Definitions; 180.62, concerning Medical Quality Review Panel;
180.64, concerning MQRP Application Process; 180.66,
concerning Medical Case Review; 180.68, concerning Medical
Quality Review Process; 180.70, concerning MQRP Training;
180.72, concerning Conflict of Interest; 180.74, concerning
MQRP Notification of Case Status; 180.76, concerning Rights
and Responsibilities of Persons Involved in the Medical Quality
Review Process; and 180.78, concerning Effective Date.
Statutory Background
These new sections are proposed due to statutory amend-
ments in House Bill 2605, enacted by the 82nd Legislature,
Regular Session, effective September 1, 2011 (HB 2605). HB
2605 added new Labor Code 413.05115, 413.05121 and
413.05122 and amended Labor Code 413.0512 to clarify
the composition and training requirements of the MQRP and
establish the Quality Assurance Panel (QAP), which is a subset
of the MQRP. Labor Code 413.0512 was amended to clarify
that the medical advisor must notify the division if the medical
advisor determines that a particular health care specialty field
is no longer necessary for inclusion on the MQRP or if there
is a need to include a particular health care specialty field
that is not currently represented on the panel. This section
was also amended to clarify that the division may enter into
agreements with other state agencies, as necessary, to access
particular health care expertise. HB 2605 added new Labor
Code 413.05121 to require the establishment of a QAP within
the MQRP to provide an additional level of evaluation in medical
case reviews, assist the medical advisor and medical quality
review panel, evaluate medical care and recommend enforce-
ment actions to the medical advisor.
HB 2605 also added new Labor Code 413.05122 to require
the Commissioner of Workers' Compensation (Commissioner) to
adopt rules concerning the operation of the medical quality re-
view panel, including rules that establish the qualifications nec-
essary for a health care provider to serve on the MQRP, the com-
position of the MQRP, the number of members to be included on
the panel and the health care specialty fields required to be rep-
resented by the members of the panel. The rules must also set
the maximum length of time a health care provider may serve on
the MQRP, a policy defining situations that constitute a conflict of
interest for a member of the MQRP, and procedures and grounds
for removing a member of the MQRP from the panel, including
as a ground for removal that a member is repeatedly delinquent
in conducting case reviews. Finally, the rules must also establish
a procedure through which members of the MQRP review panel
are notified concerning the status and enforcement outcomes of
cases resulting from the MQRP quality review process and the
training requirements for members of the MQRP.
The rules must ensure that panel members are fully aware of any
requirements imposed by the Labor Code concerning the med-ical quality review process and the Division's goals concerning
the process. The rules may require members to receive training
on any topic determined by the Division or the Commissioner
to be relevant to the operations of the panel and must require
members of the panel to receive training concerning adminis-
trative violations that affect the delivery of appropriate medical
care, the confidentiality requirements described by Labor Code
413.0513, the immunity from liability provided to members of
the panel under Labor Code 413.054, and the medical quality
review criteria adopted under Labor Code 413.05115.
The Division published an informal draft of the proposed new
sections on the Division's website from May 6, 2012 until June
6, 2012, and received eight informal comments on the proposed
rule. The Division made several changes to the proposal as a
result of the informal comments.
Description of the Proposed New Sections
Proposed New 180.60.
Proposed new 180.60 defines the terms "doctor" and "medical
case review" for purposes of this subchapter. The term "doctor"
has the same definition as Labor Code 401.011(17), a doctor
of medicine, osteopathic medicine, optometry, dentistry, podia-
try, or chiropractic who is licensed and authorized to practice.
The term "Medical Case Review" is defined as a review of medi-
cal services or professionalism in a particular case by an MQRP
member regarding the delivery of health care, or the quality of
a health care practitioner's opinion, recommendation or report.
Medical case review may include the review of a treating doc-
tor, peer review doctor, designated doctor, another health care
practitioner, an independent review organization, an insurance
carrier, or a utilization review agent.
Proposed New 180.62.
Proposed new 180.62(a) provides that the purpose of the
MQRP is to assist the medical advisor in the performance of
the medical advisor's duties under Labor Code 413.0511 in
accordance with the provisions of Labor Code 413.0512 and
413.05121.
Proposed new 180.62(b) provides that members of the MQRP
who prepare reports for medical case review shall be known
as MQRP Experts. This language mirrors Texas Medical Board
rules and helps harmonize the procedures of the two regulatory
agencies, Texas Medical Board and the Division.
Proposed new 180.62(c) provides that applicants for the MQRP
may be selected and appointed to the MQRP at the discretion of
the medical advisor and the Commissioner in accordance with
180.62.
The MQRP must have at least 25 members and must, at a mini-
mum, have members in the health care specialty fields of ortho-
pedic surgery, neurosurgery, chiropractic, occupational medicine
and pain medicine.
The MQRP may have members that include other types of health
care practitioners determined to be necessary by the medical
advisor and the Commissioner.
Proposed new 180.62(d) provides that, to be eligible to serve
on the MQRP, a health care practitioner must possess an un-
restricted license to practice in Texas, be Board certified in a
specialty or subspecialty, and have an active practice in Texas.
"Active practice" means, within either of the last two calendar
years, at the time of appointment to the MQRP, the applicant
has actively diagnosed or treated persons at least 20 hours per37 TexReg 5552 July 27, 2012 Texas Register
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
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/m1/34/: accessed March 19, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.