Tex. Labor Code Section 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 (General Definitions).

(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 (Reimbursement Policies and Guidelines; Treatment Guidelines and Protocols), 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 (List of Approved Doctors; Duties of Treating Doctors) for:

(A)

any reason described by Section 408.0231 (Maintenance of List of Approved Doctors; Sanctions and Privileges Relating to Health Care); or

(B)

noncompliance with commissioner rules;

(5)

impose conditions or restrictions as authorized by Section 408.0231 (Maintenance of List of Approved Doctors; Sanctions and Privileges Relating to Health Care)(f);

(6)

receive, and share with the medical quality review panel established under Section 413.0512 (Medical Quality Review Panel), confidential information, and other information to which access is otherwise restricted by law, as provided by Sections 413.0512 (Medical Quality Review Panel), 413.0513 (Confidentiality Requirements), and 413.0514 (Information Sharing with Occupational Licensing Boards) 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 (H.B. 7), Sec. 3.251, eff. September 1, 2005.

Source: Section 413.0511 — Medical Advisor, https://statutes.­capitol.­texas.­gov/Docs/LA/htm/LA.­413.­htm#413.­0511 (accessed Jun. 5, 2024).

413.002
Medical Review 413.003
Authority to Contract 413.004
Coordination with Providers 413.006
Advisory Committees 413.007
Information Maintained by Division 413.008
Information from Insurance Carriers 413.011
Reimbursement Policies and Guidelines 413.012
Medical Policy and Guideline Updates Required 413.013
Programs 413.014
Preauthorization Requirements 413.015
Payment by Insurance Carriers 413.016
Payments in Violation of Medical Policies and Fee Guidelines 413.017
Presumption of Reasonableness 413.018
Review of Medical Care if Guidelines Exceeded 413.019
Interest Earned for Delayed Payment, Refund, or Overpayment 413.020
Division Charges 413.021
Return-to-work Coordination Services 413.022
Return-to-work Reimbursement Program for Employers 413.023
Information to Employers 413.024
Information to Employees 413.025
Return-to-work Goals and Assistance 413.031
Medical Dispute Resolution 413.032
Independent Review Organization Decision 413.041
Disclosure 413.042
Private Claims 413.043
Overcharging Prohibited 413.044
Sanctions on Designated Doctor 413.051
Contracts with Review Organizations and Health Care Providers 413.052
Production of Documents 413.053
Standards of Reporting and Billing 413.054
Immunity from Liability 413.055
Interlocutory Orders 413.0111
Processing Agents 413.0112
Reimbursement of Federal Military Treatment Facility 413.0115
Requirements for Certain Voluntary or Informal Networks 413.0141
Initial Pharmaceutical Coverage 413.0311
Review of Medical Necessity Disputes 413.0312
Review of Medical Fee Disputes 413.0511
Medical Advisor 413.0512
Medical Quality Review Panel 413.0513
Confidentiality Requirements 413.0514
Information Sharing with Occupational Licensing Boards 413.0515
Reports of Chiropractor Violations 413.05115
Medical Quality Review Process 413.05121
Quality Assurance Panel 413.05122
Medical Quality Review Panel: Rules
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 413.0511’s source at texas​.gov