Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 12 - INDEPENDENT REVIEW ORGANIZATIONS
Subchapter C - GENERAL STANDARDS OF INDEPENDENT REVIEW
Section 12.204 - Prohibitions of Certain Activities and Relationships of Independent Review Organizations and Individuals or Entities Associated with Independent Review Organizations

Universal Citation: 28 TX Admin Code § 12.204

Current through Reg. 50, No. 13; March 28, 2025

(a) An IRO must not set or impose any notice or other review procedures that are contrary to the requirements of the health insurance policy or health benefit plan unless those requirements are set out in this chapter or Texas law.

(b) An IRO may not permit or provide compensation or anything of value to its physicians or providers that would affect, directly or indirectly, an independent review decision.

(c) An IRO may not operate out of the same office or other facility as another IRO.

(1) This prohibition extends to the shared use by IROs of the resources and staff that comprise an office, including office space, telephone and fax lines, electronic equipment, supplies, and clerical staff.

(2) This prohibition does not extend to the use of subcontractor services or personnel employed by or under contract with the IRO to perform independent review.

(d) An individual who serves as an officer, director, manager, executive, or supervisor of an IRO may not serve as an officer, director, manager, executive, supervisor, employee, agent, or independent contractor of another IRO.

(e) An individual or entity may not own more than one IRO.

(f) An individual may not own stock in more than one IRO.

(g) An individual may not serve on the board of more than one IRO.

(h) An individual who has served on the board of an IRO that has had its certificate of registration revoked for cause may not serve on the board of another IRO earlier than the fifth anniversary of the date the revocation occurred.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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