1. (a) An independent review organization shall not set or impose any notice or other review procedures that are contrary to the requirements of the health insurance policy or health benefit plan unless those requirements are set forth in this chapter or Texas law.
2. (b) An independent review organization may not permit or provide compensation or anything of value to its physicians or providers that would directly or indirectly affect an independent review decision.

3. (c) An independent review organization may not operate out of the same office or other facility as another independent review organization.

   1. (1) This prohibition extends to the shared use by independent review organizations of the resources and staff that comprise an office, including: office space, telephone and fax lines, electronic equipment, supplies, and clerical staff.
   2. (2) This prohibition does not extend to the use of subcontractor services or personnel employed by or under contract with the independent review organization to perform independent review.
4. (d) An individual or an entity may not own more than one independent review organization.
5. (e) An individual may not own stock in more than one independent review organization.
6. (f) An individual may not serve on the board of more than one independent review organization.
7. (g) An individual who has served on the board of an independent review organization that has had its certificate of registration revoked for cause may not serve on the board of another independent review organization earlier than the fifth anniversary of the date on which the revocation occurred.

8. (h) Notwithstanding §12.4(b) of this chapter (relating to Applicability), the prohibitions in subsections (c) - (g) of this section apply only to:

   1. (1) an independent review organization that:

      1. (A) is licensed on or after December 26, 2010; or
      2. (B) has its certificate of registration renewed in this state on or after December 26, 2010; and

   2. (2) an individual or entity whose activity involves an independent review organization that:

      1. (A) is licensed on or after December 26, 2010; or
      2. (B) has its certificate of registration renewed in this state on or after December 26, 2010.

Source Note:The provisions of this §12.204 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281.