This website will be unavailable from Friday, April 26, 2024 at 6:00 p.m. through Monday, April 29, 2024 at 7:00 a.m. due to data center maintenance.
Amend CSHB 7 in SECTION 1.034 of the bill, Sec. 402.168, Labor
Code (Committee Substitute page 31), by striking lines 13 through
21, and substituting the following:
"Sec. 402.168 [402.072]. SANCTIONS. (a) The department may
impose sanctions against any individual or entity monitored or
regulated by the department under this subtitle.
(b) The commissioner by rule shall establish criteria for
imposing sanctions pursuant to this subtitle. Rules adopted under
this section are in addition to, and do not affect, the rules
adopted under Section 415.023(b).
(c) The criteria for recommending or imposing sanctions may
include anything the commissioner considers relevant, including:
(1) a sanction of the doctor or other health care
provider by the department for a violation of Chapter 413 or Chapter
415;
(2) a sanction by the Medicare or Medicaid program for:
(A) substandard medical care;
(B) overcharging;
(C) overutilization of medical services; or
(D) any other substantive noncompliance with
requirements of those programs regarding professional practice or
billing;
(3) evidence from the department's medical records that
the applicable insurance carrier's utilization review practices or
the doctor's or health care provider's charges, fees, diagnoses,
treatments, evaluations, or impairment ratings are substantially
different from those the department finds to be fair and reasonable
based on either a single determination or a pattern of practice;
(4) a suspension or other relevant practice
restriction of the doctor's or other health care provider's license
by an appropriate licensing authority;
(5) professional failure to practice medicine or
provide health care, including chiropractic care, in an acceptable
manner consistent with the public health, safety, and welfare;
(6) findings of fact and conclusions of law made by a
court, an administrative law judge of the State Office of
Administrative Hearings, or a licensing or regulatory authority; or
(7) an initial criminal conviction, including a
pleading of guilty or nolo contendere, or agreeing to an order of
probation without adjudication of guilt under deferred
adjudication, without regard to whether a subsequent order allows a
withdrawal of a plea of guilty; sets aside a verdict of guilty; or
dismisses an information or indictment.
(d) The commissioner by rule shall establish procedures
under which an individual or entity may apply for restoration of
practice privileges removed by the commissioner based on sanctions
imposed under this subtitle.
(e) The department shall act on a recommendation by the
medical advisor selected under Section 413.0511 and, after notice
and the opportunity for a hearing, may impose sanctions under this
section on a doctor or other health care provider or an insurance
carrier or may recommend action regarding a utilization review
agent.
(f) Sanctions may include:
(1) a sanction that deprives a person of the right to
practice before the department under this subtitle or of the right
to receive remuneration under this subtitle;
(2) suspension or revocation of a certificate of
authority, license, certification, or permit required for practice
in the field of workers' compensation;
(3) authorizing increased or reduced utilization
review and preauthorization controls on a doctor or other health
care provider;
(4) reduction of allowable reimbursement;
(5) mandatory preauthorization of all or certain
health care services;
(6) required peer review monitoring, reporting, and
audit;
(7) deletion or suspension from the designated doctor
list;
(8) restrictions on appointment under this chapter;
(9) conditions or restrictions on an insurance carrier
regarding actions by insurance carriers under this subtitle in
accordance with the memorandum of understanding adopted between the
commission and the Texas Department of Insurance regarding Article
21.58A, Insurance Code;
(10) mandatory participation in training classes or
other courses as established or certified by the commission; and
(11) other appropriate sanction.
(g) Only the commissioner may impose:
(1) a sanction that deprives a person of the right to
practice before the department under this subtitle or of the right
to receive remuneration under this subtitle for a period exceeding
30 days; or
(2) another sanction suspending for more than 30 days
or revoking a certificate of authority, license, certification, or
permit required for practice in the field of workers' compensation.
(h) A sanction imposed by the department is binding pending
appeal.".