Texas Register, Volume 37, Number 30, Pages 5519-5676, July 27, 2012 Page: 5,555
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to information provided under this section including Labor Code
402.083 - 402.086, 402.091,402.092 and 413.0513.
Proposed New 180.76.
Proposed new 180.76 specifies rights and responsibilities of
persons involved in the Medical Quality Review Process. The
person subject to the medical quality review process has the
right to be notified that the person has been selected for a re-
view, to be notified of the disposition of the medical quality re-
view process, and to communicate with the office of the medical
advisor at any time during the medical quality review process.
The person also has a right to an informal settlement conference
(ISC) in accordance with the provisions of 180.76 as well as a
right to be represented by legal counsel. The ISC provides a per-
son subject to the Medical Quality Review Process an opportu-
nity to discuss and resolve their medical case review with MQRP
Experts. The case must have been referred to enforcement, the
request for an ISC must be in writing, the Division will notify the
requestor of the scheduled date of the ISC, the requestor has the
right to receive all documents given to the QAP members for re-
view for that particular case, all information the requestor wishes
the QAP members to consider at the ISC must be received by
the Division no later than 15 days before the ISC, and the QAP
members may refuse to consider any information not timely re-
ceived by the Division.
The ISC requestor may request to reschedule the scheduled
date of the ISC for good cause shown, in writing, as determined
by an attorney from the Division's office of general counsel.
Good cause means circumstances beyond the control of the
requestor that reasonably prevent the requestor from attending
the ISC or from requesting the rescheduling any sooner.
If a requestor fails to attend an ISC as scheduled, the requestor
forfeits his right to an ISC but does not preclude him from dis-
cussing his case with the medical advisor, from entering a Con-
sent Order, or from defending his enforcement case at the State
Office of Administrative Hearings.
Proposed new 180.76(b) specifies responsibilities. A person
subject to a medical case review must provide records and in-
formation requested from the office of the medical advisor in the
format and manner specified by the Division, provide the records
and information within the time period specified in the request,
and attach an accurate and completed business records affidavit
to the request for records and information.
Proposed New 180.78.
Proposed new 180.78 provides that this subchapter is effective
on January 1, 2013. Existing members of the MQRP on that date
shall continue to serve through the terms of their contracts. New
terms of membership after January 1, 2013 shall be established
through the process in this subchapter.
Donald Patrick, M.D., J.D., the Division's medical advisor, has
determined that for each year of the first five years the proposed
new sections will be in effect there will be minimal new fiscal im-
plications to state or local government as a result of enforcing or
administering the proposed new sections. There will be no mea-
surable fiscal effect on local employment or the local economy
as a result of the proposed new sections.
The MQRP program has historically operated through a Request
for Qualifications/Contract system with MQRP members. The
compensation for MQRP members has been determined by con-
tracts with the Division and funded by the Division. Now, thecompensation for MQRP members will be set by rule. The com-
pensation rates for MQRP members in these rules do not differ
from the compensation rates currently used by the Division for
these contracts so the cost of the MQRP program is not being
increased when compared to the current RFQ/Contract system
as a result of these rules.
These rules will increase some costs to the Division in terms of
the administration of the MQRP and the QAP. These increased
costs may include expenses associated with the preparation
of training materials and presentation of training programs for
MQRP members and division staff. However, the training pro-
gram is required by statute and not solely because of these new
rules. Dr. Patrick has determined that all duties and responsibil-
ities associated with implementing the proposed new sections
can be accomplished by utilizing existing agency resources.
Local Government and State Government as a Covered Entity.
Local government and state government as a covered regulated
entity will be impacted in the same manner as persons required
to comply with the proposed new sections as described later in
the preamble.
Dr. Patrick has also determined that for each year of the first
five years the proposed new sections will be in effect the public
benefit anticipated as a result of enforcing the new sections will
be clarity in the procedures for reviewing complaints and audits
of medical care in the workers' compensation system. It is an-
ticipated that the proposed sections will promote more effective
enforcement of quality of care issues in the Texas workers' com-
pensation system by enabling the Division to expand its access
to clinical expertise.
As required by the Government Code 2006.002(c), the Divi-
sion has determined that the proposal will not have an adverse
economic effect on the small and micro-businesses that may be
required to comply with the proposed new sections. The cost of
compliance with the proposal will not vary between large busi-
nesses and small or micro-businesses, and the Division's cost
analysis and resulting estimated costs in the Public Benefit/Cost
Note portion of this proposal is equally applicable to small or mi-
cro-businesses. Although there will be some cost incurred in
submitting an application to be on the MQRP, this cost is vol-
untary, is not significant and will not adversely impact small or
micro-businesses. Since the Division has determined that the
rule will have no adverse economic effect on small or micro-busi-
nesses preparation of an Economic Impact Statement and a
Regulatory Flexibility Analysis, as detailed under Government
Code 2006.002, is not required.
The Division has determined that no private real property inter-
ests are affected by this proposal and that this proposal does not
restrict or limit an owner's right to property that would otherwise
exist in the absence of government action and, therefore, does
not constitute a taking or require a takings impact assessment
under the Government Code 2007.043.
To be considered, written comments on the proposal
must be submitted no later than 5:00 p.m. CST on Mon-
day, August 27, 2012. Comments may be submitted
via the internet through the Division's internet website at
http://www.tdi.texas.gov/wc/rules/proposedrules/index.html, by
email at rulecomments@tdi.state.tx.us or by mailing or deliv-
ering your comments to Maria Jimenez, Texas Department of
Insurance, Division of Workers' Compensation, Workers' Com-
pensation Counsel, MS-4D, 7551 Metro Center Drive, Suite
100, Austin, Texas 78744-1645.PROPOSED RULES July 27, 2012 37 TexReg 5555
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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/m1/37/: accessed March 19, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.