1. (a) On or after January 1, 1993, except in emergency situations, injured employees must receive medical treatment from a doctor on the commission approved doctor list (the list). This list initially includes all doctors licensed in Texas on or after January 1, 1993, and doctors licensed in other jurisdictions who have been added to the list by the commission.
2. (b) Doctors licensed in other jurisdictions may ask to be added to the list by submitting a written request containing information prescribed by the commission. Unless the doctor has been deleted from the list by the commission, a carrier shall not withhold reimbursement to doctors licensed in other jurisdictions when the only reason for nonpayment is that the doctor is not presently on the list.

3. (c) Each month, the division of medical review (the division) will provide insurance carriers, through designated Austin representatives, with the names of:

   1. (1) doctors deleted from the list;
   2. (2) doctors reinstated to the list; and
   3. (3) doctors added to the list from other jurisdictions.

4. (d) Doctors may be deleted from the list for the following:

   1. (1) sanctions imposed by the commission against the doctor for violations of the Act, commission rules, or commission orders;
   2. (2) sanctions by Medicare or Medicaid for substandard medical care, overcharging, or overutilization of medical services;
   3. (3) substantial differences between the doctor's charges, fees, diagnoses, or treatments and those the commission finds to be fair and reasonable;
   4. (4) revocation or suspension of a doctor's license by the appropriate licensing authority;
   5. (5) limitations or restrictions on the professional license or disciplinary actions taken by the appropriate licensing authority;
   6. (6) criminal conviction which indicates an unwillingness or inability to provide quality treatment or to abide by the Act, commission rules, or commission orders; or
   7. (7) other activities which warrant deletion.
5. (e) The division shall notify a doctor by certified mail, return receipt requested, of the division's intent to recommend to the commissioners that the doctor be deleted from the list. Within 20 days after receiving the notice, a doctor may request a hearing as provided by Section 408.023 of the Texas Labor Code (relating to List of Approved Doctors), §2001.051 of the Texas Government Code (relating to Opportunity for Hearing and Participation), and Chapter 148 of this title (relating to Hearings Conducted by the State Office of Administrative Hearings). If a request for hearing is received, the Commission shall hold a hearing as provided in Chapter 148 of this title. If no response for hearing is filed within the time allowed, the division's recommendation will be reviewed by the Commissioners at a public meeting and a decision made to either delete or maintain the doctor on the list.
6. (f) As described in Texas Labor Code §402.072 (relating to Sanctions) and Chapter 148 of this title, only the Commissioners may delete a doctor from the list. The commission shall notify the doctor by issuing an order of deletion which describes the effects of the deletion on the doctor and the doctor's patients subject to workers' compensation. This order shall be delivered to the doctor by certified mail, return receipt requested, with a copy to the licensing authority and copies to those injured employees the commission is aware are being treated by that doctor. After receipt, the doctor shall also inform any injured employees, seeking treatment under the Act, of the doctor's deletion from the list and that the injured employee may not, except in an emergency, receive care. Failure to inform the injured employees in the form and format prescribed by the commission may subject the doctor to administrative penalties of up to $10,000 and other sanctions as provided by the Act.
7. (g) To be reinstated, a doctor deleted from the list must apply for reinstatement in the form and manner prescribed by the commission through the Medical Review Division in Austin. If, in the division's opinion, the doctor has all the appropriate unrestricted licenses to practice at the time of reinstatement, has overcome the conditions which resulted in deletion, and should be reinstated, the division shall recommend that the commissioners reinstate the doctor to the list.
8. (h) If, in the division's opinion, the doctor has not met the requirements for reinstatement, or for other reasons should not be reinstated, the division shall notify the doctor by certified mail, return receipt requested, of the division's intent to recommend to the Commissioners that the doctor not be reinstated. Within 20 days after receiving the notice, a doctor may request a hearing as provided in subsection (e) of this section.

Source Note:The provisions of this §126.8 adopted to be effective July 1, 1993, 18 TexReg 3755; amended to be effective June 7, 2001, 26 TexReg 3941.