1. (a) The commissioner shall designate annually each organization that meets the standards as an independent review organization.
2. (b) An independent review organization must apply for renewal of its certificate of registration every year, not later than the anniversary date of the issuance of the registration. Form No. LHL006 (IRO Application Form), adopted by reference in §12.102 of this subchapter (relating to Application and Renewal of Certificate of Registration Form; How To Obtain Forms), must be used for this purpose. Form No. LHL006 can be obtained from the website and from the address listed in §12.102 of this subchapter. The completed renewal form, a summary of the current review criteria, renewal fee, and a certification that no material changes exist that have not already been filed with the department must be submitted to the department at the address listed in §12.101 of this subchapter (relating to Where To File Application). Material changes shall include changes relating to physicians or providers performing independent review.
3. (c) An independent review organization may continue to operate under its certificate of registration after a completed renewal application form, application fee, and a summary of the current review criteria have been received by the department until the renewal is finally denied or issued by the department. However, independent reviews will not be assigned to an independent review organization during the 30 days prior to the anniversary date of the issuance of the independent review organization's certificate of registration unless a completed renewal application form and the application fee have been received by the department.
4. (d) If a completed renewal application form and a summary of the review criteria are not received prior to the anniversary date of the year in which the certificate of registration must be renewed, the certificate of registration will automatically expire and the independent review organization must complete and submit a new application for certificate of registration.
5. (e) The independent review organization shall report any material changes in the information required in Form No. LHL006, including changes relating to physicians and providers performing independent review, not later than the 30th day before the date on which the change takes effect.
6. (f) Compliance with subsection (e) of this section is exempted in the event that a contracted specialist is unavailable for review, and subsequent immediate contracting with a new specialist is necessary to complete independent review within the timeframes set forth in this chapter.
7. (g) The independent review organization shall notify the department within 10 days of any contracts entered into pursuant to subsection (f) of this section, and shall include in the notification a complete explanation of the circumstances necessitating such contracts.

8. (h) Until the certificate of registration renewal application process is complete or the certificate of registration expires, an independent review organization must:

   1. (1) continue to perform its duties pursuant to the Insurance Code Chapter 4202, the Labor Code, and department and TDI-DWC rules, including maintenance and retention of medical records and patient-specific information pursuant to §12.208 of this chapter (relating to Confidentiality); and
   2. (2) in regard to reviews of the medical necessity of a health care service provided under the Labor Code Title 5 or Insurance Code Chapter 1305, make responses to requests for letters of clarification pursuant to §133.308 of this title (relating to MDR by Independent Review Organizations).

Source Note:The provisions of this §12.108 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281.