Texas Administrative Code
Title 22 - EXAMINING BOARDS
Part 9 - TEXAS MEDICAL BOARD
Chapter 195 - PAIN MANAGEMENT CLINICS
Section 195.5 - Audits, Inspections and Investigations
Universal Citation: 22 TX Admin Code ยง 195.5
Current through Reg. 49, No. 38; September 20, 2024
(a) Audits.
(1) Audits are non-disciplinary reviews:
(A) conducted as an off-site document review;
and
(B) initiated by a Board
subpoena request for documents as necessary to determine or verify:
(i) exemption from application of Chapter 168
of the Act;
(ii) need to certify as
a PMC; or
(iii) no certification
requirement.
(2) A total of 30 patients records will be
reviewed during an audit. The relevant portions of the 30 records to be
reviewed are the initial visit; last two office visits; referrals; procedures
notes/logs; consultation requests; consult notes, and prior authorization
records, if any. These records will be a combination of new patients seen in
one of the last two calendar months and established patients seen in the
previous six calendar months with a minimum of 10 records for each
type.
(3) Documents requested may
also include those used to verify personnel training, qualifications, and
general compliance with Chapter 168 of the Act and related rules.
(4) Upon completion of the audit, the Board
will issue a notice of determination to the audited clinic owner. The notice of
determination will specify:
(A) Deficiencies,
if any; and
(B) If necessary, any
corrective actions the clinic must take, including a requirement to apply for
certification.
(b) Inspections.
(1) Inspections are non-disciplinary reviews:
(A) done on both certified and non-certified
clinics in accordance with Section 168.052 of the Act; and
(B) usually conducted on-site but may also be
off-site, as determined by Board staff.
(2) The following patient records will be
reviewed during an inspection, as determined by Board staff: patients seen
during two calendar months out of the previous eight months from the date of
the inspection.
(3) For certified
pain management clinics, inspections are conducted to verify compliance with
Chapter 168 of the Act and the applicable laws and rules.
(4) For non-certified clinics, inspections
are conducted to determine if the clinic is subject to be certified under
Chapter 168 of the Act.
(5) In
accordance with Section 168.052(b) of the Act, to initiate an inspection the
Board has determined the following grounds can be utilized, but are not limited
to:
(A) PMP reports;
(B) patient population analysis, including
review of patients coming from outside the immediate geographic location of the
clinic;
(C) common addresses for
multiple patients;
(D) notices to
providers from the Pharmacy Board regarding a patient having multiple
prescribing providers;
(E)
complaints about the clinic and its operation; and
(F) law enforcement reports regarding
providers or patients.
(6) Notice of intent to inspect will be
provided at least five days in advance unless such timing would compromise the
inspection.
(7) Notice of
inspection results will be provided in writing to the clinic.
(8) If the inspection determines instances of
non-compliance, the Board will determine appropriate action to obtain
compliance.
(c) Investigations may be conducted due to a complaint received or initiated by the Board. An investigation will be conducted in accordance with the provisions of this Title and all applicable Board rules.
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