CHAPTER 413. MEDICAL REVIEW
LABOR CODE
TITLE 5. WORKERS' COMPENSATION
SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT
CHAPTER 413. MEDICAL REVIEW
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 413.002. MEDICAL REVIEW. (a) The division shall monitor
health care providers, insurance carriers, independent review
organizations, and workers' compensation claimants who receive
medical services to ensure the compliance of those persons with
rules adopted by the commissioner relating to health care,
including medical policies and fee guidelines.
(b) In monitoring health care providers who serve as designated
doctors under Chapter 408 and independent review organizations
who provide services described by this chapter, the division
shall evaluate:
(1) compliance with this subtitle and with rules adopted by the
commissioner relating to medical policies, fee guidelines,
treatment guidelines, return-to-work guidelines, and impairment
ratings; and
(2) the quality and timeliness of decisions made under Section
408.0041, 408.122, 408.151, or 413.031.
(c) The division shall report the results of the monitoring of
independent review organizations under Subsection (b) to the
department on at least a quarterly basis.
(d) If the commissioner determines that an independent review
organization is in violation of this chapter, rules adopted by
the commissioner under this chapter, applicable provisions of
this code or rules adopted under this code, or applicable
provisions of the Insurance Code or rules adopted under that
code, the commissioner or a designated representative shall
notify the independent review organization of the alleged
violation and may compel the production of any documents or other
information as necessary to determine whether the violation
occurred.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.42, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.227, eff. September 1, 2005.
Sec. 413.003. AUTHORITY TO CONTRACT. The division may contract
with a private or public entity to perform a duty or function of
the division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.228, eff. September 1, 2005.
Sec. 413.004. COORDINATION WITH PROVIDERS. The division shall
coordinate its activities with health care providers as necessary
to perform its duties under this chapter. The coordination may
include:
(1) conducting educational seminars on commissioner rules and
procedures; or
(2) providing information to and requesting assistance from
professional peer review organizations.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.229, eff. September 1, 2005.
Sec. 413.006. ADVISORY COMMITTEES. The commissioner may appoint
advisory committees as the commissioner considers necessary.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.230, eff. September 1, 2005.
Sec. 413.007. INFORMATION MAINTAINED BY DIVISION. (a) The
division shall maintain a statewide data base of medical charges,
actual payments, and treatment protocols that may be used by:
(1) the commissioner in adopting the medical policies and fee
guidelines; and
(2) the division in administering the medical policies, fee
guidelines, or rules.
(b) The division shall ensure that the data base:
(1) contains information necessary to detect practices and
patterns in medical charges, actual payments, and treatment
protocols; and
(2) can be used in a meaningful way to allow the commission to
control medical costs as provided by this subtitle.
(c) The division shall ensure that the data base is available
for public access for a reasonable fee established by the
commissioner. The identities of injured workers and
beneficiaries may not be disclosed.
(d) The division shall take appropriate action to be aware of
and to maintain the most current information on developments in
the treatment and cure of injuries and diseases common in
workers' compensation cases.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.231, eff. September 1, 2005.
Sec. 413.008. INFORMATION FROM INSURANCE CARRIERS;
ADMINISTRATIVE VIOLATION. (a) On request from the division for
specific information, an insurance carrier shall provide to the
division any information in the carrier's possession, custody, or
control that reasonably relates to the division's duties under
this subtitle and to health care:
(1) treatment;
(2) services;
(3) fees; and
(4) charges.
(b) The division shall keep confidential information that is
confidential by law.
(c) An insurance carrier commits an administrative violation if
the insurance carrier fails or refuses to comply with a request
or violates a rule adopted to implement this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.232, eff. September 1, 2005.
SUBCHAPTER B. MEDICAL SERVICES AND FEES
For expiration of Subsections (d-1), (d-2), (d-3),and (d-6), see
Subsection (d-6)
Sec. 413.011. REIMBURSEMENT POLICIES AND GUIDELINES; TREATMENT
GUIDELINES AND PROTOCOLS. (a) The commissioner shall adopt
health care reimbursement policies and guidelines that reflect
the standardized reimbursement structures found in other health
care delivery systems with minimal modifications to those
reimbursement methodologies as necessary to meet occupational
injury requirements. To achieve standardization, the
commissioner shall adopt the most current reimbursement
methodologies, models, and values or weights used by the federal
Centers for Medicare and Medicaid Services, including applicable
payment policies relating to coding, billing, and reporting, and
may modify documentation requirements as necessary to meet the
requirements of Section 413.053.
(b) In determining the appropriate fees, the commissioner shall
also develop one or more conversion factors or other payment
adjustment factors taking into account economic indicators in
health care and the requirements of Subsection (d). The
commissioner shall also provide for reasonable fees for the
evaluation and management of care as required by Section
408.025(c) and commissioner rules. This section does not adopt
the Medicare fee schedule, and the commissioner may not adopt
conversion factors or other payment adjustment factors based
solely on those factors as developed by the federal Centers for
Medicare and Medicaid Services.
(c) This section may not be interpreted in a manner that would
discriminate in the amount or method of payment or reimbursement
for services in a manner prohibited by Section 1451.104,
Insurance Code, or as restricting the ability of chiropractors to
serve as treating doctors as authorized by this subtitle. The
commissioner shall also develop guidelines relating to fees
charged or paid for providing expert testimony relating to an
issue arising under this subtitle.
(d) Fee guidelines must be fair and reasonable and designed to
ensure the quality of medical care and to achieve effective
medical cost control. The guidelines may not provide for payment
of a fee in excess of the fee charged for similar treatment of an
injured individual of an equivalent standard of living and paid
by that individual or by someone acting on that individual's
behalf. The commissioner shall consider the increased security
of payment afforded by this subtitle in establishing the fee
guidelines.
(d-1) Notwithstanding Subsections (b) through (d) and Section
413.016, an insurance carrier may pay fees to a health care
provider that are inconsistent with the fee guidelines adopted by
the division if the insurance carrier, or a network under Chapter
1305, Insurance Code, arranging out-of-network services under
Section 1305.006, Insurance Code, has a contract with the health
care provider and that contract includes a specific fee schedule.
An insurance carrier or the carrier's authorized agent may use
an informal or voluntary network, as those terms are defined by
Section 413.0115, to obtain a contractual agreement that provides
for fees different from the fees authorized under the division's
fee guidelines. If a carrier or the carrier's authorized agent
chooses to use an informal or voluntary network to obtain a
contractual fee arrangement, there must be a contractual
arrangement between:
(1) the carrier or authorized agent and the informal or
voluntary network that authorizes the network to contract with
health care providers on the carrier's behalf; and
(2) the informal or voluntary network and the health care
provider that includes a specific fee schedule and complies with
the notice requirements established under Subsection (d-2).
(d-2) An informal or voluntary network, or the carrier or the
carrier's authorized agent, as appropriate, shall notify each
health care provider of any person that is given access to the
network's fee arrangements with that health care provider within
the time and according to the manner provided by commissioner
rule.
(d-3) An insurance carrier shall provide copies of each contract
described by Subsection (d-1) to the division on the request of
the division. Information included in a contract under
Subsection (d-1) is confidential and is not subject to disclosure
under Chapter 552, Government Code. For medical fee disputes
that arise regarding non-network and out-of-network care, the
division may request that copies of each contract under which
fees are being paid be submitted to the division for review.
Notwithstanding Subsection (d-1) or Section 1305.153, Insurance
Code, the insurance carrier may be required to pay fees in
accordance with the division's fee guidelines if the contract:
(1) is not provided in a timely manner to the division on the
division's request;
(2) does not include a specific fee schedule consistent with
Subsection (d-1); and
(3) does not:
(A) clearly state that the contractual fee arrangement is
between the health care provider and the named insurance carrier
or the named insurance carrier's authorized agent; or
(B) comply with the notice requirements under Subsection (d-2).
Text of subsection effective on January 01, 2011
(d-4) Notwithstanding this section or any other provision of
this title, an insurance carrier, an insurance carrier's
authorized agent, or a network certified under Chapter 1305,
Insurance Code, arranging for non-network services or
out-of-network services under Section 1305.006, Insurance Code,
may continue to contract with a health care provider to secure
health care for an injured employee for fees that exceed the fees
adopted by the division under this section.
(d-5) The commissioner and the commissioner of insurance may
adopt rules as necessary to implement this section.
(d-6) Subsections (d-1) through (d-3) and this subsection expire
January 1, 2011.
(e) The commissioner by rule shall adopt treatment guidelines
and return-to-work guidelines and may adopt individual treatment
protocols. Treatment guidelines and protocols must be
evidence-based, scientifically valid, and outcome-focused and
designed to reduce excessive or inappropriate medical care while
safeguarding necessary medical care. Treatment may not be denied
solely on the basis that the treatment for the compensable injury
in question is not specifically addressed by the treatment
guidelines.
(f) In addition to complying with the requirements of Subsection
(e), medical policies or guidelines adopted by the commissioner
must be:
(1) designed to ensure the quality of medical care and to
achieve effective medical cost control;
(2) designed to enhance a timely and appropriate return to work;
and
(3) consistent with Sections 413.013, 413.020, 413.052, and
413.053.
(g) The commissioner may adopt rules relating to disability
management that are designed to promote appropriate health care
at the earliest opportunity after the injury to maximize injury
healing and improve stay-at-work and return-to-work outcomes
through appropriate management of work-related injuries or
conditions. The commissioner by rule may identify claims in
which application of disability management activities is required
and prescribe at what point in the claim process a treatment plan
is required. The determination may be based on any factor
considered relevant by the commissioner. Rules adopted under
this subsection do not apply to claims subject to workers'
compensation health care networks under Chapter 1305, Insurance
Code.
(h) A dispute involving a treatment plan required under
Subsection (g) may be appealed to an independent review
organization in the manner described by Section 413.031.
(i) The division shall examine whether injured employees have
reasonable access to surgically implanted, inserted, or otherwise
applied devices or tissues and investigate whether reimbursement
rates or any other barriers exist that reduce the ability of an
injured employee to access those medical needs. The division
shall recommend to the legislature any statutory changes
necessary to ensure appropriate access to those medical needs.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.02, eff. June
17, 2001; Acts 2003, 78th Leg., ch. 962, Sec. 1, 2, eff. June 20,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.233, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1177, Sec. 2, eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch.
1177, Sec. 2, eff. January 1, 2011.
Sec. 413.0111. PROCESSING AGENTS. The rules adopted by the
commissioner for the reimbursement of prescription medications
and services must authorize pharmacies to use agents or assignees
to process claims and act on the behalf of the pharmacies under
terms and conditions agreed on by the pharmacies.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.234, eff. September 1, 2005.
Sec. 413.0115. REQUIREMENTS FOR CERTAIN VOLUNTARY OR INFORMAL
NETWORKS. (a) In this section:
(1) "Informal network" means a health care provider network
described by Section 413.011(d-1) that:
(A) is established under a contract between an insurance carrier
and health care providers; and
(B) includes a specific fee schedule.
(2) "Voluntary network" means a voluntary workers' compensation
health care delivery network established by an insurance carrier
under former Section 408.0223, as that section existed before
repeal by Chapter 265, Acts of the 79th Legislature, Regular
Session, 2005.
(b) Not later than January 1, 2011, each informal network or
voluntary network must be certified as a workers' compensation
health care network under Chapter 1305, Insurance Code.
(c) Effective September 1, 2007, each informal network and
voluntary network must provide the following information to the
division:
(1) an executive contact for official correspondence for the
network;
(2) a toll-free telephone number by which a health care provider
may contact the informal network or voluntary network;
(3) a list of each insurance carrier with whom the network
contracts; and
(4) a list of each entity associated with the network working on
behalf of the insurance carrier, including contact information
for each entity.
(d) Each informal network and voluntary network shall report any
changes to the information provided under Subsection (c) to the
division not later than the 30th day after the effective date of
the change.
Added by Acts 2007, 80th Leg., R.S., Ch.
1177, Sec. 3, eff. September 1, 2007.
Sec. 413.012. MEDICAL POLICY AND GUIDELINE UPDATES REQUIRED.
The medical policies and fee guidelines shall be reviewed and
revised at least every two years to reflect fair and reasonable
fees and to reflect medical treatment or ranges of treatment that
are reasonable or necessary at the time the review and revision
is conducted.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 413.013. PROGRAMS. The commissioner by rule shall
establish:
(1) a program for prospective, concurrent, and retrospective
review and resolution of a dispute regarding health care
treatments and services;
(2) a program for the systematic monitoring of the necessity of
treatments administered and fees charged and paid for medical
treatments or services, including the authorization of
prospective, concurrent, or retrospective review under the
medical policies of the division to ensure that the medical
policies or guidelines are not exceeded;
(3) a program to detect practices and patterns by insurance
carriers in unreasonably denying authorization of payment for
medical services requested or performed if authorization is
required by the medical policies of the division; and
(4) a program to increase the intensity of review for compliance
with the medical policies or fee guidelines for any health care
provider that has established a practice or pattern in charges
and treatments inconsistent with the medical policies and fee
guidelines.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.235, eff. September 1, 2005.
Sec. 413.014. PREAUTHORIZATION REQUIREMENTS; CONCURRENT REVIEW
AND CERTIFICATION OF HEALTH CARE. (a) In this section,
"investigational or experimental service or device" means a
health care treatment, service, or device for which there is
early, developing scientific or clinical evidence demonstrating
the potential efficacy of the treatment, service, or device but
that is not yet broadly accepted as the prevailing standard of
care.
(b) The commissioner by rule shall specify which health care
treatments and services require express preauthorization or
concurrent review by the insurance carrier. Treatments and
services for a medical emergency do not require express
preauthorization.
(c) The commissioner's rules adopted under this section must
provide that preauthorization and concurrent review are required
at a minimum for:
(1) spinal surgery, as provided by Section 408.026;
(2) work-hardening or work-conditioning services provided by a
health care facility that is not credentialed by an organization
recognized by commissioner rules;
(3) inpatient hospitalization, including any procedure and
length of stay;
(4) physical and occupational therapy;
(5) outpatient or ambulatory surgical services, as defined by
commissioner rule; and
(6) any investigational or experimental services or devices.
(d) The insurance carrier is not liable for those specified
treatments and services requiring preauthorization unless
preauthorization is sought by the claimant or health care
provider and either obtained from the insurance carrier or
ordered by the commissioner.
(e) If a specified health care treatment or service is
preauthorized as provided by this section, that treatment or
service is not subject to retrospective review of the medical
necessity of the treatment or service.
(f) The division may not prohibit an insurance carrier and a
health care provider from voluntarily discussing health care
treatment and treatment plans and pharmaceutical services, either
prospectively or concurrently, and may not prohibit an insurance
carrier from certifying or agreeing to pay for health care
consistent with those agreements. The insurance carrier is
liable for health care treatment and treatment plans and
pharmaceutical services that are voluntarily preauthorized and
may not dispute the certified or agreed-on preauthorized health
care treatment and treatment plans and pharmaceutical services at
a later date.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 4.02, eff. June
17, 2001; Acts 2003, 78th Leg., ch. 980, Sec. 1, eff. Sept. 1,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.236, eff. September 1, 2005.
Sec. 413.0141. INITIAL PHARMACEUTICAL COVERAGE. The
commissioner may by rule provide that an insurance carrier shall
provide for payment of specified pharmaceutical services
sufficient for the first seven days following the date of injury
if the health care provider requests and receives verification of
insurance coverage and a verbal confirmation of an injury from
the employer or from the insurance carrier as provided by Section
413.014. The rules adopted by the commissioner shall provide
that an insurance carrier is eligible for reimbursement for
pharmaceutical services paid under this section from the
subsequent injury fund in the event the injury is determined not
to be compensable.
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 4.03, eff. June 17,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.237, eff. September 1, 2005.
Sec. 413.015. PAYMENT BY INSURANCE CARRIERS; AUDIT AND REVIEW.
(a) Insurance carriers shall make appropriate payment of charges
for medical services provided under this subtitle. An insurance
carrier may contract with a separate entity to forward payments
for medical services. Any payment due the insurance carrier from
the separate entity must be made in accordance with the contract.
The separate entity is subject to the direction of the insurance
carrier, and the insurance carrier is responsible for the actions
of the separate entity under this subsection.
(b) The commissioner shall provide by rule for the review and
audit of the payment by insurance carriers of charges for medical
services provided under this subtitle to ensure compliance of
health care providers and insurance carriers with the medical
policies and fee guidelines adopted by the commissioner.
(c) The rules must require the insurance carrier to pay the
expenses of the review and audit.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.03, eff. June
17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.238, eff. September 1, 2005.
Sec. 413.016. PAYMENTS IN VIOLATION OF MEDICAL POLICIES AND FEE
GUIDELINES. (a) The division shall order a refund of charges
paid to a health care provider in excess of those allowed by the
medical policies or fee guidelines. The division shall also refer
the health care provider alleged to have violated this subtitle
to the division of compliance and practices.
(b) If the division determines that an insurance carrier has
paid medical charges that are inconsistent with the medical
policies or fee guidelines adopted by the commissioner, the
division shall investigate the potential violation. If the
insurance carrier reduced a charge of a health care provider that
was within the guidelines, the insurance carrier shall be
directed to submit the difference to the provider unless the
reduction is in accordance with an agreement between the health
care provider and the insurance carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.239, eff. September 1, 2005.
Sec. 413.017. PRESUMPTION OF REASONABLENESS. The following
medical services are presumed reasonable:
(1) medical services consistent with the medical policies and
fee guidelines adopted by the commissioner; and
(2) medical services that are provided subject to prospective,
concurrent, or retrospective review as required by the medical
policies of the division and that are authorized by an insurance
carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.240, eff. September 1, 2005.
Sec. 413.018. REVIEW OF MEDICAL CARE IF GUIDELINES EXCEEDED.
(a) The commissioner by rule shall provide for the periodic
review of medical care provided in claims in which guidelines for
expected or average return to work time frames are exceeded.
(b) The division shall review the medical treatment provided in
a claim that exceeds the guidelines and may take appropriate
action to ensure that necessary and reasonable care is provided.
(c) The division shall implement a program to encourage
employers and treating doctors to discuss the availability of
modified duty to encourage the safe and more timely return to
work of injured employees. The division may require a treating
or examining doctor, on the request of the employer, insurance
carrier, or division, to provide a functional capacity evaluation
of an injured employee and to determine the employee's ability to
engage in physical activities found in the workplace or in
activities that are required in a modified duty setting.
(d) The division shall provide through the division's health and
safety information and medical review outreach programs
information to employers regarding effective return to work
programs. This section does not require an employer to provide
modified duty or an employee to accept a modified duty
assignment. An employee who does not accept an employer's offer
of modified duty determined by the division to be a bona fide job
offer is subject to Section 408.103(e).
(e) The commissioner may adopt rules and forms as necessary to
implement this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 956, Sec. 3, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.241, eff. September 1, 2005.
Sec. 413.019. INTEREST EARNED FOR DELAYED PAYMENT, REFUND, OR
OVERPAYMENT. (a) Interest on an unpaid fee or charge that is
consistent with the fee guidelines accrues at the rate provided
by Section 401.023 beginning on the 60th day after the date the
health care provider submits the bill to an insurance carrier
until the date the bill is paid.
(b) Interest on a refund from a health care provider accrues at
the rate provided by Section 401.023 beginning on the 60th day
after the date the provider receives notice of alleged
overpayment from the insurance carrier until the date the refund
is paid.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 413.020. DIVISION CHARGES. The commissioner by rule shall
establish procedures to enable the division to charge:
(1) an insurance carrier a reasonable fee for access to or
evaluation of health care treatment, fees, or charges under this
subtitle; and
(2) a health care provider who exceeds a fee or utilization
guideline established under this subtitle or an insurance carrier
who unreasonably disputes charges that are consistent with a fee
or utilization guideline established under this subtitle a
reasonable fee for review of health care treatment, fees, or
charges under this subtitle.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.242, eff. September 1, 2005.
Sec. 413.021. RETURN-TO-WORK COORDINATION SERVICES. (a) An
insurance carrier shall, with the agreement of a participating
employer, provide the employer with return-to-work coordination
services on an ongoing basis as necessary to facilitate an
employee's return to employment, including on receipt of a notice
that an injured employee is eligible to receive temporary income
benefits. The insurance carrier shall notify the employer of the
availability of the return-to-work reimbursement program under
Section 413.022. The insurance carrier shall evaluate a
compensable injury in which the injured employee sustains an
injury that could potentially result in lost time from employment
as early as practicable to determine if skilled case management
is necessary for the injured employee's case. As necessary, case
managers who are appropriately certified shall be used to perform
these evaluations. A claims adjuster may not be used as a case
manager. These services may be offered by insurance carriers in
conjunction with the accident prevention services provided under
Section 411.061. Nothing in this section supersedes the
provisions of a collective bargaining agreement between an
employer and the employer's employees, and nothing in this
section authorizes or requires an employer to engage in conduct
that would otherwise be a violation of the employer's obligations
under the National Labor Relations Act (29 U.S.C. Section 151 et
seq.).
(b) Return-to-work coordination services under this section may
include:
(1) job analysis to identify the physical demands of a job;
(2) job modification and restructuring assessments as necessary
to match job requirements with the functional capacity of an
employee; and
(3) medical or vocational case management to coordinate the
efforts of the employer, the treating doctor, and the injured
employee to achieve timely return to work.
(c) An insurance carrier is not required to provide physical
workplace modifications under this section and is not liable for
the cost of modifications made under this section to facilitate
an employee's return to employment.
(d) The division shall use certified rehabilitation counselors
or other appropriately trained or credentialed specialists to
provide training to division staff regarding the coordination of
return-to-work services under this section.
(e) The commissioner shall adopt rules necessary to collect data
on return-to-work outcomes to allow full evaluations of successes
and of barriers to achieving timely return to work after an
injury.
(f) Repealed by Acts 2003, 78th Leg., 3rd C.S., ch. 10, Sec.
1.02(a).
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 3.02, eff. June 17,
2001. Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 10, Sec.
1.02(a), eff. Oct. 20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.243, eff. September 1, 2005.
Acts 2009, 81st Leg., R.S., Ch.
1388, Sec. 1, eff. June 19, 2009.
Sec. 413.022. RETURN-TO-WORK REIMBURSEMENT PROGRAM FOR
EMPLOYERS; FUND. (a) In this section:
(1) "Account" means the workers' compensation return-to-work
account.
(2) "Eligible employer" means any employer, other than this
state or a political subdivision subject to Subtitle C, who has
workers' compensation insurance coverage and who:
(A) employed at least two but not more than 50 employees on each
business day during the preceding calendar year; or
(B) is a type of employer designated as eligible to participate
in the program by the commissioner.
(3) "Program" means the return-to-work reimbursement program
established under this section.
(b) The commissioner shall establish by rule a return-to-work
reimbursement program designed to promote the early and sustained
return to work of an injured employee who sustains a compensable
injury. The commissioner, by rule, may expand eligibility to
participate in the program to types of employers who are not
described by Subsection (a)(2)(A).
(c) The program shall reimburse from the account an eligible
employer for expenses incurred by the employer to make workplace
modifications necessary to accommodate an injured employee's
return to modified or alternative work. Reimbursement under this
section to an eligible employer may not exceed $5,000. The
expenses must be incurred to allow the employee to perform
modified or alternative work within doctor-imposed work
restrictions. Allowable expenses may include:
(1) physical modifications to the worksite;
(2) equipment, devices, furniture, or tools; and
(3) other costs necessary for reasonable accommodation of the
employee's restrictions.
(c-1) The commissioner by rule shall establish an optional
preauthorization plan for eligible employers who participate in
the program. To participate in the preauthorization plan, an
employer must submit a proposal to the division, in the manner
prescribed by the division, that describes the workplace
modifications and other changes that the employer proposes to
make to accommodate an injured employee's return to work. If the
division approves the employer's proposal, the division shall
guarantee reimbursement of the expenses incurred by the employer
in implementing the modifications and changes from the account
unless the division determines that the modifications and changes
differ materially from the employer's proposal. If determined to
be a public purpose by the commissioner, and in accordance with
rules adopted by the commissioner, the division may provide the
employer an advance of funds under this subsection. Reimbursement
or an advance of funds under this subsection is subject to the
limit imposed under Subsection (c).
(d) The account is established as a special account in the
general revenue fund. From administrative penalties received by
the division under this subtitle, the commissioner shall deposit
in the account an amount not to exceed $100,000 annually. Money
in the account may be spent by the division, on appropriation by
the legislature, only for the purposes of implementing this
section.
(e) An employer who wilfully applies for or receives
reimbursement from the account under this section knowing that
the employer is not an eligible employer commits a violation.
(f) Notwithstanding Subsections (a)-(e), this section may be
implemented only to the extent funds are available.
(g) The commissioner shall adopt rules as necessary to implement
this section.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.244, eff. September 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
106, Sec. 1, eff. May 17, 2007.
Acts 2009, 81st Leg., R.S., Ch.
1388, Sec. 2, eff. June 19, 2009.
Acts 2009, 81st Leg., R.S., Ch.
1388, Sec. 3, eff. June 19, 2009.
Acts 2009, 81st Leg., R.S., Ch.
1388, Sec. 4, eff. June 19, 2009.
Sec. 413.023. INFORMATION TO EMPLOYERS. (a) The division shall
provide employers with information on methods to enhance the
ability of an injured employee to return to work. The
information may include access to available research and best
practice information regarding return-to-work programs for
employers.
(b) The division shall augment return-to-work program
information provided to employers to include information
regarding methods for an employer to appropriately assist an
injured employee to obtain access to doctors who:
(1) provide high-quality care; and
(2) use effective occupational medicine treatment practices that
lead to returning employees to productive work.
(c) The information provided to employers under this section
must help to foster:
(1) effective working relationships with local doctors and with
insurance carriers or workers' compensation health care networks
certified under Chapter 1305, Insurance Code, to improve
return-to-work communication; and
(2) access to return-to-work coordination services provided by
insurance carriers.
(d) The division shall develop and make available the
information described by this section.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.244, eff. September 1, 2005.
Sec. 413.024. INFORMATION TO EMPLOYEES. The division shall
provide injured employees with information regarding the benefits
of early return to work. The information must include
information on how to receive assistance in accessing
high-quality medical care through the workers' compensation
system.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.244, eff. September 1, 2005.
Sec. 413.025. RETURN-TO-WORK GOALS AND ASSISTANCE. (a) The
division shall assist recipients of income benefits to return to
the workforce. The division shall develop improved data sharing,
within the standards of federal privacy requirements, with all
appropriate state agencies and workforce programs to inform the
division of changes needed to assist income benefit recipients to
successfully reenter the workforce.
(b) The division shall train staff dealing with income benefits
to respond to questions and assist injured employees in their
effort to return to the workforce. If the division determines
that an injured employee is unable to ever return to the
workforce, the division shall inform the employee of possible
eligibility for other forms of benefits, such as social security
disability income benefits.
(c) As necessary to implement the requirements of this section,
the division shall:
(1) attempt to remove any barriers to successful employment that
are identified at the division, the Texas Workforce Commission,
the Department of Assistive and Rehabilitative Services, and
private vocational rehabilitation programs;
(2) ensure that data is tracked among the division, the Texas
Workforce Commission, the Department of Assistive and
Rehabilitative Services, and insurance carriers, including
outcome data;
(3) establish a mechanism to refer income benefit recipients to
the Texas Workforce Commission and local workforce development
centers for employment opportunities; and
(4) develop a mechanism to promote employment success that
includes post-referral contacts by the division with income
benefit recipients.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.244, eff. September 1, 2005.
SUBCHAPTER C. DISPUTE RESOLUTION
Sec. 413.031. MEDICAL DISPUTE RESOLUTION. (a) A party,
including a health care provider, is entitled to a review of a
medical service provided or for which authorization of payment is
sought if a health care provider is:
(1) denied payment or paid a reduced amount for the medical
service rendered;
(2) denied authorization for the payment for the service
requested or performed if authorization is required or allowed by
this subtitle or commissioner rules;
(3) ordered by the commissioner to refund a payment received; or
(4) ordered to make a payment that was refused or reduced for a
medical service rendered.
(b) A health care provider who submits a charge in excess of the
fee guidelines or treatment policies is entitled to a review of
the medical service to determine if reasonable medical
justification exists for the deviation. A claimant is entitled
to a review of a medical service for which preauthorization is
sought by the health care provider and denied by the insurance
carrier. The commissioner shall adopt rules to notify claimants
of their rights under this subsection.
(c) In resolving disputes over the amount of payment due for
services determined to be medically necessary and appropriate for
treatment of a compensable injury, the role of the division is to
adjudicate the payment given the relevant statutory provisions
and commissioner rules. The division shall publish on its
Internet website the division's medical dispute decisions,
including decisions of independent review organizations, and any
subsequent decisions by the State Office of Administrative
Hearings. Before publication, the division shall redact only
that information necessary to prevent identification of the
injured worker.
(d) A review of the medical necessity of a health care service
requiring preauthorization under Section 413.014 or commissioner
rules under that section or Section 413.011(g) shall be conducted
by an independent review organization under Chapter 4202,
Insurance Code, in the same manner as reviews of utilization
review decisions by health maintenance organizations. It is a
defense for the insurance carrier if the carrier timely complies
with the decision of the independent review organization.
(e) Except as provided by Subsections (d), (f), and (m), a
review of the medical necessity of a health care service provided
under this chapter or Chapter 408 shall be conducted by an
independent review organization under Chapter 4202, Insurance
Code, in the same manner as reviews of utilization review
decisions by health maintenance organizations. It is a defense
for the insurance carrier if the carrier timely complies with the
decision of the independent review organization.
(e-1) In performing a review of medical necessity under
Subsection (d) or (e), the independent review organization shall
consider the division's health care reimbursement policies and
guidelines adopted under Section 413.011. If the independent
review organization's decision is contrary to the division's
policies or guidelines adopted under Section 413.011, the
independent review organization must indicate in the decision the
specific basis for its divergence in the review of medical
necessity.
(e-2) Notwithstanding Section 4202.002, Insurance Code, an
independent review organization that uses doctors to perform
reviews of health care services provided under this title may
only use doctors licensed to practice in this state.
(e-3) Notwithstanding Subsections (d) and (e) of this section or
Chapters 4201 and 4202, Insurance Code, a doctor, other than a
dentist or a chiropractor, who performs a utilization review or
an independent review of a health care service provided to an
injured employee is subject to Section 408.0043. A dentist who
performs a utilization review or an independent review of a
dental service provided to an injured employee is subject to
Section 408.0044. A chiropractor who performs a utilization
review or an independent review of a chiropractic service
provided to an injured employee is subject to Section 408.0045.
(f) The commissioner by rule shall specify the appropriate
dispute resolution process for disputes in which a claimant has
paid for medical services and seeks reimbursement.
(g) In performing a review of medical necessity under Subsection
(d) or (e), an independent review organization may request that
the commissioner order an examination by a designated doctor
under Chapter 408.
(h) The insurance carrier shall pay the cost of the review if
the dispute arises in connection with:
(1) a request for health care services that require
preauthorization under Section 413.014 or commissioner rules
under that section; or
(2) a treatment plan under Section 413.011(g) or commissioner
rules under that section.
(i) Except as provided by Subsection (h), the cost of the review
shall be paid by the nonprevailing party.
(j) Notwithstanding Subsections (h) and (i), an employee may not
be required to pay any portion of the cost of a review.
(k) A party to a medical dispute, other than a medical dispute
regarding spinal surgery subject to Subsection (l) and a dispute
subject to Section 413.0311, that remains unresolved after a
review of the medical service under this section is entitled to a
hearing. A hearing under this subsection shall be conducted by
the State Office of Administrative Hearings not later than the
60th day after the date on which the party notifies the division
of the request for a hearing. The hearing shall be conducted in
the manner provided for a contested case under Chapter 2001,
Government Code.
(k-1) A party who has exhausted all administrative remedies
under Subsection (k) and who is aggrieved by a final decision of
the State Office of Administrative Hearings may seek judicial
review of the decision. Judicial review under this subsection
shall be conducted in the manner provided for judicial review of
a contested case under Subchapter G, Chapter 2001, Government
Code.
(k-2) The division and the department are not considered to be
parties to the medical dispute for purposes of Subsections (k)
and (k-1).
(l) A party to a medical dispute regarding spinal surgery that
remains unresolved after a review by an independent review
organization as provided by Subsections (d) and (e) is entitled
to dispute resolution as provided by Chapter 410.
(m) The decision of an independent review organization under
Subsection (d) is binding during the pendency of a dispute.
(n) The commissioner by rule may prescribe an alternate dispute
resolution process to resolve disputes regarding medical services
costing less than the cost of a review of the medical necessity
of a health care service by an independent review organization.
The cost of a review under the alternate dispute resolution
process shall be paid by the nonprevailing party.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff.
Sept. 1, 1995; Acts 1995, 74th Leg., ch. 980, Sec. 1.43, eff.
Sept. 1, 1995; Acts 2001, 77th Leg., ch. 1456, Sec. 6.04, eff.
June 17, 2001; Acts 2003, 78th Leg., ch. 980, Sec. 2, eff. Sept.
1, 2003; Acts 2003, 78th Leg., ch. 1323, Sec. 1, eff. June 21,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.245, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
133, Sec. 2, eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch.
1007, Sec. 1, eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch.
1218, Sec. 6, eff. September 1, 2007.
Acts 2009, 81st Leg., R.S., Ch.
1330, Sec. 18, eff. September 1, 2009.
Sec. 413.0311. REVIEW OF CERTAIN MEDICAL DISPUTES; CONTESTED
CASE HEARING. (a) This section applies only to the following
medical disputes that remain unresolved after any applicable
review under Sections 413.031(b) through (i):
(1) a medical fee dispute in which the amount of reimbursement
sought by the requestor in its request for medical dispute
resolution does not exceed $2,000;
(2) an appeal of an independent review organization decision
regarding determination of the retrospective medical necessity
for a health care service for which the amount billed does not
exceed $3,000; and
(3) an appeal of an independent review organization decision
regarding determination of the concurrent or prospective medical
necessity for a health care service.
(b) A party to a medical dispute described by Subsection (a) is
entitled to a contested case hearing. A contested case hearing
under this section shall be conducted by a hearings officer in
the manner provided for contested case hearings under Subchapter
D, Chapter 410. Notwithstanding Section 410.024, a benefit
review conference is not a prerequisite to a contested case
hearing under this section.
(c) The decision of a hearings officer under this section is
final in the absence of a timely appeal by a party for judicial
review under Subsection (d).
(d) A party who has exhausted all administrative remedies under
Section 413.031 and this section and who is aggrieved by a final
decision of the hearings officer under Subsection (c) may seek
judicial review of the decision. Judicial review under this
subsection shall be conducted in the manner provided for judicial
review of a contested case under Subchapter G, Chapter 2001,
Government Code.
(e) The division and the department are not considered to be
parties to the medical dispute for purposes of this section.
Added by Acts 2007, 80th Leg., R.S., Ch.
1007, Sec. 2, eff. September 1, 2007.
Sec. 413.032. INDEPENDENT REVIEW ORGANIZATION DECISION; APPEAL.
(a) An independent review organization that conducts a review
under this chapter shall specify the elements on which the
decision of the organization is based. At a minimum, the
decision must include:
(1) a list of all medical records and other documents reviewed
by the organization;
(2) a description and the source of the screening criteria or
clinical basis used in making the decision;
(3) an analysis of and explanation for the decision, including
the findings and conclusions used to support the decision; and
(4) a description of the qualifications of each physician or
other health care provider who reviews the decision.
(b) The independent review organization shall certify that each
physician or other health care provider who reviews the decision
certifies that no known conflicts of interest exist between that
provider and the injured employee, the injured employee's
employer, the injured employee's insurance carrier, the
utilization review agent, or any of the treating doctors or
insurance carrier health care providers who reviewed the case for
decision before referral to the independent review organization.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.247, eff. September 1, 2005.
SUBCHAPTER D. HEALTH CARE PROVIDERS
Sec. 413.041. DISCLOSURE. (a) Each health care practitioner
shall disclose to the division the identity of any health care
provider in which the health care practitioner, or the health
care provider that employs the health care practitioner, has a
financial interest. The health care practitioner shall make the
disclosure in the manner provided by commissioner rule.
(b) The commissioner shall require by rule that a doctor
disclose financial interests in other health care providers as a
condition of registration for the approved doctor list
established under Section 408.023 and shall define "financial
interest" for purposes of this section as provided by analogous
federal regulations. The commissioner by rule shall adopt the
federal standards that prohibit the payment or acceptance of
payment in exchange for health care referrals relating to fraud,
abuse, and antikickbacks.
(c) A health care provider that fails to comply with this
section is subject to penalties and sanctions as provided by this
subtitle, including forfeiture of the right to reimbursement for
services rendered during the period of noncompliance.
(d) The division shall publish all final disclosure enforcement
orders issued under this section on the division's Internet
website.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.05, eff. June
17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.246, eff. September 1, 2005.
Sec. 413.042. PRIVATE CLAIMS; ADMINISTRATIVE VIOLATION. (a) A
health care provider may not pursue a private claim against a
workers' compensation claimant for all or part of the cost of a
health care service provided to the claimant by the provider
unless:
(1) the injury is finally adjudicated not compensable under this
subtitle; or
(2) the employee violates Section 408.022 relating to the
selection of a doctor and the doctor did not know of the
violation at the time the services were rendered.
(b) A health care provider commits an administrative violation
if the provider violates Subsection (a).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.248, eff. September 1, 2005.
Sec. 413.043. OVERCHARGING PROHIBITED; OFFENSE. (a) A health
care provider commits an offense if the person knowingly charges
an insurance carrier an amount greater than that normally charged
for similar treatment to a payor outside the workers'
compensation system, except for mandated or negotiated charges.
(b) An offense under this section is a Class A misdemeanor.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 413.044. SANCTIONS ON DESIGNATED DOCTOR. (a) In addition
to or in lieu of an administrative penalty under Section 415.021
or a sanction imposed under Section 415.023, the commissioner may
impose sanctions against a person who serves as a designated
doctor under Chapter 408 who, after an evaluation conducted under
Section 413.002(b), is determined by the division to be out of
compliance with this subtitle or with rules adopted by the
commissioner relating to:
(1) medical policies, fee guidelines, and impairment ratings; or
(2) the quality of decisions made under Section 408.0041 or
Section 408.122.
(b) Sanctions imposed under Subsection (a) may include:
(1) removal or suspension from the division list of designated
doctors; or
(2) restrictions on the reviews made by the person as a
designated doctor.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.44, eff. Sept. 1,
1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.249, eff. September 1, 2005.
SUBCHAPTER E. IMPLEMENTATION OF COMMISSION POWERS AND DUTIES
Sec. 413.051. CONTRACTS WITH REVIEW ORGANIZATIONS AND HEALTH
CARE PROVIDERS. (a) In this section, "health care provider
professional review organization" includes an independent review
organization.
(b) The division may contract with a health care provider,
health care provider professional review organization, or other
entity to develop, maintain, or review medical policies or fee
guidelines or to review compliance with the medical policies or
fee guidelines.
(c) For purposes of review or resolution of a dispute as to
compliance with the medical policies or fee guidelines, the
division may contract with a health care provider, health care
provider professional review organization, or other entity that
includes in the review process health care practitioners who are
licensed in the category under review and are of the same field
or specialty as the category under review.
(d) The division may contract with a health care provider,
health care provider professional review organization, or other
entity for medical consultant services, including:
(1) independent medical examinations;
(2) medical case reviews; or
(3) establishment of medical policies and fee guidelines.
(e) The commissioner shall establish standards for contracts
under this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 1.02, eff. June
17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.250, eff. September 1, 2005.
Sec. 413.0511. MEDICAL ADVISOR. (a) The division shall employ
or contract with a medical advisor, who must be a doctor as that
term is defined by Section 401.011.
(b) The medical advisor shall make recommendations regarding the
adoption of rules and policies to:
(1) develop, maintain, and review guidelines as provided by
Section 413.011, including rules regarding impairment ratings;
(2) review compliance with those guidelines;
(3) regulate or perform other acts related to medical benefits
as required by the commissioner;
(4) impose sanctions or delete doctors from the division's list
of approved doctors under Section 408.023 for:
(A) any reason described by Section 408.0231; or
(B) noncompliance with commissioner rules;
(5) impose conditions or restrictions as authorized by Section
408.0231(f);
(6) receive, and share with the medical quality review panel
established under Section 413.0512, confidential information, and
other information to which access is otherwise restricted by law,
as provided by Sections 413.0512, 413.0513, and 413.0514 from the
Texas State Board of Medical Examiners, the Texas Board of
Chiropractic Examiners, or other occupational licensing boards
regarding a physician, chiropractor, or other type of doctor who
applies for registration or is registered with the division on
the list of approved doctors;
(7) determine minimal modifications to the reimbursement
methodology and model used by the Medicare system as necessary to
meet occupational injury requirements; and
(8) monitor the quality and timeliness of decisions made by
designated doctors and independent review organizations, and the
imposition of sanctions regarding those decisions.
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 1.02, eff. June 17,
2001. Amended by Acts 2003, 78th Leg., ch. 963, Sec. 1, eff. June
20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.251, eff. September 1, 2005.
Sec. 413.0512. MEDICAL QUALITY REVIEW PANEL. (a) The medical
advisor shall establish a medical quality review panel of health
care providers to assist the medical advisor in performing the
duties required under Section 413.0511. The panel is not subject
to Chapter 2110, Government Code.
(b) The Texas State Board of Medical Examiners and the Texas
Board of Chiropractic Examiners, with input from their respective
professional associations, shall develop lists of physicians and
chiropractors licensed by those agencies who have demonstrated
experience in workers' compensation or utilization review. The
medical advisor shall consider appointing some of the members of
the medical quality review panel from the names on those lists.
The medical advisor shall also consider nominations for the panel
made by labor, business, and insurance organizations.
(c) The medical quality review panel shall recommend to the
medical advisor:
(1) appropriate action regarding doctors, other health care
providers, insurance carriers, utilization review agents, and
independent review organizations; and
(2) the addition or deletion of doctors from the list of
approved doctors under Section 408.023 or the list of designated
doctors established under Section 408.1225.
(d) A person who serves on the medical quality review panel is
immune from suit and from civil liability for an act performed,
or a recommendation made, within the scope of the person's
functions as a member of the panel if the person acts without
malice and in the reasonable belief that the action or
recommendation is warranted by the facts known to that person. In
the event of a civil action brought against a member of the panel
that arises from the person's participation on the panel, the
person is entitled to the same protections afforded a commission
member under Section 402.010.
(e) The actions of a person serving on the medical quality
review panel do not constitute utilization review and are not
subject to Article 21.58A, Insurance Code.
(f) A member of the medical quality review panel, other than a
chiropractor, who reviews a specific workers' compensation case
is subject to Section 408.0043. A chiropractor who reviews a
specific workers' compensation case is subject to Section
408.0045.
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 1.02, eff. June 17,
2001. Amended by Acts 2003, 78th Leg., ch. 963, Sec. 2, eff. June
20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.252, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1218, Sec. 7, eff. September 1, 2007.
Sec. 413.0513. CONFIDENTIALITY REQUIREMENTS. (a) Information
collected, assembled, or maintained by or on behalf of the
division under Section 413.0511 or 413.0512 constitutes an
investigation file for purposes of Section 402.092 and may not be
disclosed under Section 413.0511 or 413.0512 except as provided
by that section.
(b) Confidential information, and other information to which
access is restricted by law, developed by or on behalf of the
division under Section 413.0511 or 413.0512 is not subject to
discovery or court subpoena in any action other than:
(1) an action to enforce this subtitle brought by the division,
an appropriate licensing or regulatory agency, or an appropriate
enforcement authority; or
(2) a criminal proceeding.
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 1.02, eff. June 17,
2001. Amended by Acts 2003, 78th Leg., ch. 963, Sec. 3, eff. June
20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.253, eff. September 1, 2005.
Sec. 413.0514. INFORMATION SHARING WITH OCCUPATIONAL LICENSING
BOARDS. (a) This section applies only to information held by or
for the division, the Texas State Board of Medical Examiners, and
Texas Board of Chiropractic Examiners that relates to a person
who is licensed or otherwise regulated by any of those state
agencies.
(b) The division and the Texas State Board of Medical Examiners
on requ