| (a) Qualifications to get or renew certification. The
division will not assign examinations to a designated doctor who does
not meet all requirements for certification or renewal. All designated
doctors must:
(1) Have a complete designated doctor certification
application as described in subsection (b) of this section on file
with the division.
(2) Complete all division-required trainings within
12 months of the date of application and have current documentation
confirming their completion on file with the division.
(3) Pass all division-required testing on the specific
duties of a designated doctor under the Labor Code and division rules
and have current documentation confirming their passage on file with
the division. Required testing must have been completed on or after
May 13, 2013, and includes demonstrated proficient knowledge of the
currently adopted edition of:
(A) the American Medical Association Guides to the
Evaluation of Permanent Impairment; and
(B) the division's adopted:
(i) treatment guidelines; and
(ii) return-to-work guidelines.
(4) Have maintained an active practice for at least
three years during the doctor's career. For the purposes of this subsection,
a doctor has an active practice if the doctor maintains or has maintained
routine office hours of at least 20 hours per week for 40 weeks per
year to treat patients.
(5) For the duration of the doctor's term as a designated
doctor:
(A) be licensed in Texas;
(B) own or subscribe to the current edition of the
American Medical Association Guides to the Evaluation of Permanent
Impairment adopted by the division to assign impairment ratings and
all return-to-work and treatment guidelines adopted by the division;
and
(C) comply with financial disclosure requirements in §180.24
(relating to Financial Disclosure) of this title.
(b) Application. To be considered complete, an application
for certification must include, and a renewal application must update
or confirm:
(1) contact information for the doctor;
(2) information on the doctor's education;
(3) a description of the doctor's license or licenses,
certifications, and professional specialty, if any;
(4) a description of the doctor's work history and
hospital or other health care provider affiliations;
(5) a description of any affiliations the doctor has
with a workers' compensation health care network certified under Insurance
Code Chapter 1305 or political subdivision under Labor Code §504.053(b)(2);
(6) information on the doctor's current practice locations;
(7) detailed answers to disclosure questions on the
doctor's professional background, education, training, and fitness
to perform the duties of a designated doctor, including disclosure
and summary of any disciplinary actions taken against the doctor by
any state licensing board or other appropriate state or federal agency;
(8) the identity of any person the doctor has contracted
with to assist in performing or administering the doctor's designated
doctor duties;
(9) an attestation that:
(A) all information provided in the application is
accurate and complete to the best of the doctor's knowledge;
(B) the doctor will inform the division of any changes
to this information as required by §127.200(a)(8) of this title
(relating to Duties of a Designated Doctor); and
(C) the doctor will consent to any on-site visits,
as provided by §127.200(a)(15) of this title, by the division
at facilities that the designated doctor uses or intends to use to
perform designated doctor examinations for the duration of the doctor's
certification.
(c) Retesting. If a doctor passes a division-required
test, the doctor may not retest within a twelve-month period. If a
doctor fails a division-required test, the doctor may not retest more
than three times within a six-month period.
(1) After the first or second attempt, the doctor must
wait 14 days before retaking the test.
(2) After the third attempt, the doctor must wait six
months before retaking the test.
(d) Additional certification testing. On receipt of
an application for designated doctor certification renewal, the division
may require a designated doctor to complete additional certification
testing to demonstrate proficient knowledge on the specific duties
of a designated doctor under the Labor Code and division rules. Examples
of circumstances that may require additional certification testing
include, but are not limited to, individual need for retesting based
on substandard performance, changes in the duties of a designated
doctor, updates to the guidelines, and legislative changes.
(e) Notice of approval, denial, suspension, or revocation.
The division will notify a doctor in writing of the commissioner's
approval or denial of the doctor's application to be certified or
renewed as a designated doctor; or of the division's suspension or
revocation of the doctor's certification.
(f) Term and qualification. Approvals certify a doctor
for a term of two years and will include:
(1) the effective date of the certification;
(2) the expiration date of the certification; and
(3) the designated doctor's examination qualifications
under §127.130 of this title (relating to Qualification Standards
for Designated Doctor Examinations).
(g) Renewal. A designated doctor who seeks to renew
their certification immediately after their current term expires,
without interruption, must apply for certification no later than 45
days before the end of the term.
(1) If the division does not receive all of the information
required under subsection (b)(1) - (9) above no later than 45 days
before the end of the designated doctor's term, the division will
not assign examinations to the designated doctor during the last 45
days of an expiring term.
(2) The designated doctor may still provide services
on claims the division had previously assigned to them during this
45-day period.
(h) Approval of renewal application with restrictions.
An application for renewal may be approved with restrictions. The
division may restrict a designated doctor's certification until the
doctor complies with the requirements in the designated doctor's approval
of certification. Designated doctors whose certification is restricted
may dispute the restriction through the procedure described in subsection
(k) of this section.
(i) Adverse certification actions. The division may
deny, suspend, or revoke a designated doctor's certification for any
of the following reasons:
(1) if the doctor did not submit a complete application
for certification as required under subsection (b) of this section;
(2) for having a relevant restriction on their practice
imposed by a state licensing board, certification authority, or other
appropriate state or federal agency, including the division;
(3) if the doctor failed to update their application
for certification properly; or
(4) for other activities, events, or occurrences that
the commissioner determines warrant denial of a doctor's application
for certification as a designated doctor, including, but not limited
to:
(A) the quality of the designated doctor's past reports;
(B) the designated doctor's history of complaints;
(C) excess requests for deferral from the designated
doctor list by the designated doctor;
(D) a pattern of overturned reports by the division
or a court;
(E) a demonstrated lack of ability to apply or properly
consider the American Medical Association Guides to the Evaluation
of Permanent Impairment adopted by the division to assign impairment
ratings and all return-to-work and treatment guidelines adopted by
the division;
(F) a demonstrated lack of ability to consistently
perform designated doctor examinations in a timely manner;
(G) a demonstrated failure to identify disqualifying
associations;
(H) a demonstrated lack of ability to ensure the confidentiality
of injured employee medical records and claim information provided
to or generated by a designated doctor;
(I) a history of unnecessary referral examinations
or testing;
(J) a failure to comply with the requirements of §180.24
of this title (relating to Financial Disclosure) when they requested
referral examinations or additional testing;
(K) applying for certification less than a year from
denial of a previous designated doctor certification application;
or
Cont'd... |
