Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 127 - DESIGNATED DOCTOR PROCEDURES AND REQUIREMENTS
Subchapter C - DESIGNATED DOCTOR DUTIES AND RESPONSIBILITIES
Section 127.200 - Duties of a Designated Doctor
Universal Citation: 28 TX Admin Code ยง 127.200
Current through Reg. 49, No. 38; September 20, 2024
(a) Duties. All designated doctors must:
(1) Perform
designated doctor examinations in a facility:
(A) currently used and properly equipped for
medical examinations or other similar health care services; and
(B) that ensures safety, privacy, and
accessibility for injured employees, injured employee medical records, and
other records containing confidential claim information.
(2) Ensure the confidentiality of medical
records, analyses, and forms provided to or generated by the designated doctor
in the doctor's capacity as a designated doctor for the duration of the
retention period specified in §
127.10(i) of this
title (relating to General Procedures for Designated Doctor Examinations) and
ensure the destruction of these medical records after both this retention
period expires and the designated doctor determines the information is no
longer needed.
(3) Ensure that all
agreements with persons that permit those parties to perform designated doctor
administrative duties, including, but not limited to, billing and scheduling
duties, on the designated doctor's behalf:
(A)
are in writing and signed by the designated doctor and the persons with whom
the designated doctor is contracting;
(B) define the administrative duties that the
person may perform on behalf of the designated doctor;
(C) require the persons to comply with all
confidentiality provisions of the Labor Code and other applicable
laws;
(D) comply with all medical
billing and payment requirements under Chapter 133 of this title (relating to
General Medical Provisions);
(E) do
not constitute an improper inducement relating to the delivery of benefits to
an injured employee under Labor Code §§415.0036 and §
180.25 of this title (relating to
Improper Inducements, Influence and Threats); and
(F) are made available to the division on
request.
(4) Notify the
division in writing and in advance if the designated doctor voluntarily defers
their availability to receive any offers of examinations for personal or other
reasons. The notice must specify the duration and reason for the
deferral.
(5) Notify the division
in writing and in advance if the designated doctor no longer wishes to practice
as a designated doctor before the doctor's current certification as a
designated doctor expires. A designated doctor who no longer wishes to practice
before their current certification expires must expressly surrender their
certification in a signed, written statement to the division.
(6) Be physically present in the same room as
the injured employee for the designated doctor examination or any other health
care service provided to the injured employee that is not referred to another
health care provider under §
127.10(c) of this
title.
(7) Apply the appropriate
edition of the American Medical Association Guides to the Evaluation of
Permanent Impairment and division-adopted return-to-work guidelines under
§137.10 (relating to Return to Work Guidelines) and consider
division-adopted treatment guidelines under §137.100 (relating to
Treatment Guidelines) or other evidence-based medicine when
appropriate.
(8) Provide the
division with updated information within 10 working days of a change in any
information they provide to the division on their application for
certification.
(9) Maintain a
professional and courteous demeanor when performing the duties of a designated
doctor, including, but not limited to, explaining the purpose of a designated
doctor examination to an injured employee at the beginning of the examination
and using non-inflammatory, appropriate language in all reports and documents
they produce.
(10) Bill for
designated doctor examinations and receive payment for those examinations in
accordance with Chapters 133 and 134 of this title (relating to
Benefits--Guidelines for Medical Services, Charges, and Payments).
(11) Respond timely to all division
appointments, clarifications, document requests, or other division
inquiries.
(12) Notify the division
if their continued participation on a claim they have already been assigned
would exceed the scope of practice authorized by their license.
(13) Not perform required medical
examinations, utilization reviews, or peer reviews on a claim they have been
assigned as a designated doctor.
(14) Identify themselves at the beginning of
every designated doctor examination.
(15) Consent to and cooperate during any
on-site visits by the division under §
180.4 of this title (relating to
On-Site Visits).
(A) Notwithstanding §
180.4(e)(2) of
this title, the division's purpose for these visits is to ensure the designated
doctor's compliance with the Labor Code and applicable division
rules.
(B) The notice provided to
the designated doctor under §
180.4 of this title, either in
advance or at the time of the on-site visit, will specify the duties the
division will investigate during that visit.
(16) Cooperate with all division compliance
audits and quality reviews.
(17)
Complete required training or pass required testing detailed in the designated
doctor's approval of certification.
(18) Comply with all applicable laws and
rules.
(b) Agents. For the purposes of this chapter, Chapter 180 of this title (relating to Monitoring and Enforcement), and all other applicable laws and division rules, any person with whom a designated doctor contracts or otherwise permits to perform designated doctor administrative duties on behalf of the designated doctor qualifies as the doctor's "agent" as defined under § 180.1 of this title (relating to Definitions).
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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