Current through Reg. 49, No. 38; September 20, 2024
(a) Purpose. The
purpose of the Medical Quality Review Panel (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,
413.05121,
and
413.05122.
(b) Experts. Members of the MQRP who prepare
reports for medical case review will be known as MQRP Experts.
(c) Composition. Applicants may be selected
and appointed to the MQRP at the discretion of the medical advisor and the
commissioner of workers' compensation (commissioner) in accordance with this
section. The MQRP must be composed of health care practitioners appointed by
the medical advisor and the commissioner in accordance with this section.
(1) The MQRP must have at least 25
members.
(2) The MQRP must, at a
minimum, have members in the following health care specialty fields:
(A) Orthopedic Surgery--A medical doctor (MD)
or a doctor of osteopathy (DO) with board certification in orthopedic
surgery.
(B) Neurosurgery--An MD or
DO with board certification in neurological surgery.
(C) Chiropractic--A licensed doctor of
chiropractic.
(D) Occupational
Medicine--An MD or DO with board certification in occupational
medicine.
(E) Pain Medicine--An MD
or DO with a board certification in a subspecialty of anesthesiology,
neurology, or physical medicine.
(3) The MQRP may have members that include
other types of health care practitioners determined to be necessary by the
medical advisor and the commissioner.
(d) Eligibility. To be eligible to serve on
the MQRP, a health care practitioner must meet the following criteria, as
applicable:
(1) Possess an unrestricted
license to practice in Texas with the appropriate credentials, as defined by
§
180.1 of
this title (relating to Definitions);
(2) Be board certified in a specialty or
subspecialty. An MD or DO is board-certified in a specialty or subspecialty if
the MD or DO holds:
(A) a general certificate
in the specialty or a subspecialty certificate from one of the member boards of
the American Board of Medical Specialties (ABMS); or
(B) a primary certificate in the specialty
and:
(i) a certificate of special
qualifications from the American Osteopathic Association Bureau of Osteopathic
Specialists (AOABOS); or
(ii) a
certificate of added qualifications in the subspecialty from the
AOABOS.
(3) Be
in 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:
(A) actively diagnosed or treated persons at
least 20 hours per week for 40 weeks duration during a given calendar year;
or
(B) performed administrative,
leadership, or advisory roles in the practice of medicine.
(4) The medical advisor and the commissioner
may waive the requirements of paragraphs (2) and (3) of this subsection if
needed to adequately perform medical case review.
(e) Term; Resignation; Removal.
(1) MQRP members will be appointed for a
maximum term of 10 years. They will serve until the expiration of their term,
until their resignation, or until their removal from the MQRP. The division
will review MQRP members periodically during their term to ensure their
continued eligibility.
(2) An MQRP
member may submit a new application for membership in the MQRP after the term
expires.
(3) An MQRP member may
resign from the MQRP at any time.
(4) An MQRP member may be removed from the
MQRP for cause at any time. The notice of removal will state the date of
removal, which may be immediately after the member receives the notice or on a
specified future date. Causes for removal include, but are not limited to:
(A) Failure to maintain eligibility under
this subchapter.
(B) Failure to
timely inform the division of conflicts of interest.
(C) Repeated failure to timely review medical
case review assignments or timely submit reports to the division.
(D) Repeated failure to prepare the reports
in the prescribed format.
(E) Other
issues deemed sufficient by the medical advisor or commissioner.
(f) Prohibition. An MQRP
member must not use his or her position to influence an insurance carrier,
agent, or other person or entity in connection with a personal or other
insurance-related matter beyond referring to their position to demonstrate
qualifications.
(g) Quality
Assurance Panel.
(1) The medical advisor will
establish the Quality Assurance Panel (QAP) within the MQRP. All members of the
QAP are members of the MQRP. They perform all the duties of an MQRP member
under Labor Code §
413.0512,
as well as the duties of a QAP member under Labor Code §
413.05121.
(2) A member of the QAP will also be known as
an Arbiter.
(3) QAP members may
provide any services to the medical advisor provided by Labor Code §§
413.0512,
413.05121,
and
413.05122,
including, but not limited to:
(A) Serving as
the chair to the quality assurance committee.
(B) Serving as expert witnesses in
enforcement actions as appropriate.
(C) Providing an additional level of medical
expertise and quality assurance to assist the medical advisor in the medical
advisor's duties under Labor Code §
413.0511.
(D) Performing medical case review if no
other MQRP member is available in a specific area of expertise. In this case,
the Arbiter would be ineligible from participating in the informal settlement
process for the subject the Arbiter reviewed.
