When substantiated by credible evidence, the following acts, practices, and conduct are considered to be violations of the Act. The following shall not be considered an exhaustive or exclusive listing. (1)Practice Inconsistent with Public Health and Welfare. Failure to practice in an acceptable professional manner consistent with public health and welfare within the meaning of the Act includes, but is not limited to: (A) - (N)(No change.) (O)Failure to follow standard procedures necessary to make a reasoned medical decision in the assessment and/or determination of the medical necessity of treatment for another individual, entity, or organization, including: (i)reviewing relevant information that is reasonably available, subject to legally-imposed time limits; (ii)communicating with the treating physician as reasonably necessary to clarify information; (iii)consulting with another physician with appropriate expertise, if the case includes issues that are outside the expertise of the physician reviewer; and (iv)documenting a reasoned medical analysis. (2) - (6)(No change.)
This agency hereby certifies that the proposal
has been reviewed by legal counsel and found to be within the agency's
legal authority to adopt.
Filed with the Office
of the Secretary of State on July 6, 2007
TRD-200702860 Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board
Earliest possible date of adoption: August 19, 2007
For further information, please call: (512) 305-7016
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