The Commissioner of Workers' Compensation adopted amendments to 28 TAC §180.22, and adopted new §180.28, effective August 16, 2006. The purpose of this bulletin is to alert you to certain changes in the law regarding peer reviews.
House Bill 7, enacted by the 79th Texas Legislature, Regular Session, amended Labor Code §408.0231 to add subsection (g). Subsection (g) requires in part that, "A doctor who performs peer review under this subtitle must hold the appropriate professional licensure issued by this state." In addition, Labor Code §408.023(h) states, "Notwithstanding Section 4(h), Article 21.58A, Texas Insurance Code, a utilization review agent that uses doctors to perform reviews of health care services provided under this subtitle may use doctors licensed by another state to perform the reviews, but the reviews must be performed under the direction of a doctor licensed to practice in this state." Accordingly, all carriers and utilization review agents that use doctors to perform peer reviews will be held accountable and may be subject to sanctions and disciplinary action for the peer reviewer's conduct that is not in compliance with the Texas Workers' Compensation Act or other applicable law.
Further, the Commissioner of Workers' Compensation adopted 28 TAC §§180.22 and 180.28 in order to better monitor peer reviews in accordance with Labor Code §§408.023(h) and 408.0231(g). If a health care provider, including a health care provider not licensed in Texas, does not comply with the statute and these rules, the Division may impose sanctions, which include the restriction, suspension, or removal of the provider's ability to perform peer review in the workers' compensation system.
To ensure compliance, it is essential that you review the entire text of the Labor Code §§408.023 and 408.0231, the recently adopted rules 28 TAC §§180.22 and 180.28, as well as any other applicable statutes and rules. The Commissioner's Order and full text of the new section may be accessed on the Division's web site at http://www.tdi.state.tx.us/wc/rules/adopted/adopted.html. Please refer to Commissioner's Order Number DWC-06-0036.
For further information or questions regarding this bulletin, contact Stanton Strickland, Deputy Commissioner, Legal & Compliance Division at 512-804-4715 or by e-mail at Stan.Strickland@tdi.state.tx.us .
Sincerely,
Albert Betts
Commissioner of Workers Compensation
Texas Department of Insurance