| (a) All designated doctors shall:
(1) perform designated doctor examinations in a facility
currently used and properly equipped for medical examinations or other
similar health care services and that ensures safety, privacy, and
accessibility for injured employees and 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 person(s) 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 person(s) 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 person or persons to comply with all
confidentiality provisions of the Act and other applicable laws;
(D) comply with all medical billing and payment requirements
under Chapter 133 of this title (relating to General Medical Benefits);
(E) do not constitute an improper inducement relating
to the delivery of benefits to and injured employee under Labor Code
§415.0036 and §180.25 of this title (relating to Improper
Inducements, Influence and Threats); and
(F) made available to the division upon request;
(4) notify the division in writing and in advance if
the designated doctor voluntarily decides to defer the designated
doctor's availability to receive any offers of examinations for personal
or other reasons and the notice must specify the duration of 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 as a
designated doctor before the doctor's current certification expires
must expressly surrender the designated doctor's 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 and consider division-adopted 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 of the information provided to
the division on the doctor's application for certification or recertification
as a designated doctor;
(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
produced by the designated doctor;
(10) bill for designated doctor examinations and receive
payment for those examinations in accordance with Chapter 133 of this
title and Chapter 134 of this title (relating to Benefits--Guidelines
for Medical Services, Charges, and Payments);
(11) respond timely to all division appointment, clarification,
or document requests, or other division inquiries;
(12) notify the division if a designated doctor's continued
participation on a claim to which the designated doctor has already
been assigned would required the doctor to exceed the scope of practice
authorized by the doctor's license;
(13) not perform required medical examinations, utilization
reviews, or peer reviews on a claim to which the designated doctor
has 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 pursuant to §180.4 of this title (relating to
On-Site Visits); notwithstanding §180.4(e)(2) of this title,
the division's purpose for these visits will be to ensure the designated
doctor's compliance with the Act and applicable division rules, and
the notice provided to the designated doctor in accordance with §180.4
of this title, either in advance of or at the time of the on-site
visit, will specify the duties being investigated by the division
during that visit;
(16) cooperate with all division compliance audits,
quality reviews; and
(17) otherwise comply with all applicable laws and
rules.
(b) 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).
(c) This section will become effective on September
1, 2012.
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