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§ 180.64. MQRP Application Process

(a) To apply to the MQRP, a person must submit an application in the form and manner required by the division demonstrating compliance with the required qualifications. The application must contain complete information as provided by subsection (b) of this section. The medical advisor and the Commissioner may select and appoint only qualified applicants to the division’s MQRP but are not required to accept all applicants who meet the requirements specified in this subchapter.

(b) The division’s required application form for the MQRP, at a minimum, shall include:

(1) contact information for the health care practitioner;

(2) information about the health care practitioner’s education;

(3) a description of the health care practitioner’s license(s), certifications, and professional specialty, if any;

(4) a description of the health care practitioner’s work history and hospital or other health care practitioner affiliations;

(5) a description of any affiliations the health care practitioner has with a workers’ compensation health care network certified under Chapter 1305 of the Insurance Code or a political subdivision as described in Labor Code § 504.053(b)(2);

(6) identification of and a description of all current and past medical review affiliations, including but not limited to an independent review organization (IRO), utilization review agent (URA), licensing board, and insurance carrier;

(7) information regarding the health care practitioner’s current practice locations;

(8) disclosure regarding the health care practitioner’s professional background, education, training, and fitness to perform the duties of an MQRP member, including disclosure of any disciplinary actions or other sanctions taken against the health care practitioner by any state licensing board, state or federal agency, and hospital or other health care institution, as well as disclosure of any voluntary relinquishments, drug and alcohol misuse, malpractice claims history and criminal history;

(9) a description of all ownership interests or other financial arrangements, such as salaried or contract employment, involving a person or their agent subject to the Act or a rule, order, or decision of the commissioner;

(10) an authorization for third parties to release information relevant to the verification of the information provided on the application to the division;

(11) an affirmation that all information provided in the application is accurate and complete to the best of the health care practitioner’s knowledge; and

(12) an affirmation of understanding of the legal requirements, including confidentiality provisions, for MQRP members.

(c) A credentialing application for hospital credentialing may substitute for some items under subsection (b) of this section.

(d) The health care practitioner must inform the medical advisor of any changes to this information within 30 days after the change.

(e) The application shall be reviewed by the medical advisor.

(f) The medical advisor and the commissioner have the discretion to select, appoint and remove an applicant to the MQRP.

(g) Membership in the MQRP is for a term of two years. The acceptance letter will include the effective date and expiration date.

(h) Membership in the MQRP is not a guarantee of any number of assignments.

(i) MQRP members shall be entitled to compensation for work assigned by the medical advisor at the following hourly rates:

(1) Doctors–Medical case reviews, ad hoc work groups, or special projects: $150 per hour.

(2) Non-Doctors–Medical case reviews, ad hoc work groups or special projects: $100 per hour.

(3) Limits on hours. A member shall not be paid for more than:

(A) five hours for a medical case review of a single case;

(B) five hours for ad hoc work group or special project service; or

(C) 20 hours in a given calendar month.

(4) The medical advisor may approve additional hours in writing upon review of a submitted narrative report or a report of an ad hoc work group.

(5) Hearings or trial preparation.

(A) Doctors–Payment for time spent in hearing or in trial preparation, in providing testimony in deposition, hearing or trial: $350 per hour.

(B) Non-doctors–Payment for time spent in hearing or in trial preparation, in providing testimony in deposition, hearing or trial: $175 per hour.

(C) An MQRP member shall not be paid for more than eight hours per day for a deposition, a hearing, trial preparation or court testimony. If travel is required, the division will pay the member for travel, lodging and per diem expenses in accordance with the Texas State Travel Management Program, 34 TAC § 20.301 et seq.

(6) The division may vary the above reimbursement provisions if deemed by the division to be in the best interests of the division or the State of Texas.

(j) In accordance with Labor Code §§ 402.083-402.086, 402.091, 402.092, and 413.0513, an MQRP member may not disclose confidential information, including a report or other documentation prepared by the MQRP member for the division.

(k) All reports and related documents, including electronic and non-electronic data, prepared by or furnished to the member for the MQRP, are the sole property of the division.

The provisions of this §180.64 adopted to be effective January 1, 2013, 37 TexReg 8839.

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At a Glance:

Title:

§ 180.64. MQRP Application Process

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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