| (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.
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| Source Note: The provisions of this §12.204 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281; amended to be effective July 7, 2015, 40 TexReg 2538 |
