| (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.
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