1. (a) This section identifies the training requirements for doctors to be certified to provide various services within the Texas workers' compensation system.
2. (b) The commission, in order to ensure that injured employees (employees) have access to health care and insurance carriers (carriers) have access to evaluations of an employee's health care and income benefit eligibility, may grant exceptions that allow a doctor to avoid certain training and registration requirements or to perform functions not normally permitted by the doctor's Certification Level. Such exceptions shall be granted on a per request, per case basis. When an exception is granted, the commission shall provide a copy of the approval to the carrier.

3. (c) Doctors on the approved doctor list (ADL) shall be classified as either Level 1 or Level 2 doctors.

   1. (1) Level 1 Certification allows a doctor to:

      1. (A) infrequently provide health care to employees (providing care, other than emergency or immediate post-injury medical care, to 18 Texas workers' compensation claimants or fewer per calendar year);
      2. (B) perform utilization review or peer review functions for a carrier; and/or
      3. (C) participate in a regional network established under Texas Labor Code §408.0221.
   2. (2) Level 2 Certification allows a doctor to serve in any role authorized in the Texas workers' compensation system with the exception of serving as a designated doctor unless the doctor is also on the designated doctor list which is governed by §180.21 of this title (relating to the Commission Designated Doctor List).
4. (d) A doctor seeking admission to the ADL shall receive training from the commission and/or a commission-approved trainer.
5. (e) A person or organization seeking to become a commission-approved trainer shall apply for approval in the form and manner prescribed by the commission.
6. (f) For each doctor trained, the commission-approved trainer shall file or provide the doctor's training information in the form and manner prescribed by the commission.

7. (g) Notwithstanding any other subsection of this section:

   1. (1) a doctor not licensed in this state shall not perform utilization reviews and/or peer reviews for an insurance carrier or its agent unless the doctor performs the reviews under the direction of a doctor who:

      1. (A) is licensed in this state,
      2. (B) is on the ADL at Level 2 Certification, and
      3. (C) has agreed to direct the doctor's reviews; and
   2. (2) the commission may restrict or reduce a doctor's privileges or authorizations as provided in the Statute or Rules.

8. (h) ADL approval at a minimum requires a doctor to successfully complete commission-prescribed training prior to admission and continued approved-status at a minimum requires a doctor to successfully complete follow-up training as required.

   1. (1) Required training shall focus on the requirements of the Texas workers' compensation system with an emphasis on return to work, efficient utilization of care, entitlement to benefits, maximum medical improvement (MMI), and the determination of the existence of permanent impairment.
   2. (2) Training may be completed through either self-study/distance learning (including online) or by attending training in person, as available.
   3. (3) Level 1 Certification requires completing the Limited Participation Doctor Training Module. Level 2 Certification requires completing the Doctor Training Module.
   4. (4) Level 1 Certification requires follow-up training every two years. Level 2 Certification requires follow-up training every four years. Follow-up training will serve as a refresher course but emphasize relevant changes in the Statute and Rules.

9. (i) This subsection governs authorization relating to certification of MMI, determination of permanent impairment, and assignment of impairment ratings in the event that a doctor finds permanent impairment exists when the examination of the employee occurs on or after September 1, 2003.

   1. (1) Any doctor on the ADL is authorized to determine whether an employee has permanent impairment resulting from a compensable injury. If the doctor finds that the employee does not have permanent impairment, the doctor is also authorized to certify the employee as reaching MMI.
   2. (2) Full authorization to assign an impairment rating and certify MMI in an instance where the employee is found to have permanent impairment requires a doctor to receive commission certification by successfully completing the commission-prescribed Impairment Rating Training Module and passing the test. To remain certified, a doctor is required to successfully complete follow-up training and testing every four years.
   3. (3) A doctor who has not completed the commission-prescribed training under subsection (i)(2) of this section but who has had similar training in the AMA Guides from a commission-approved vendor within the prior two years may submit the syllabus and training materials from that course to the commission for review. If the commission determines that the training is substantially the same as the commission-prescribed training and the doctor passes the commission-prescribed test, the doctor is fully authorized under this subsection. The ability to substitute training only applies to the initial training requirement, not the follow-up training.
   4. (4) Notwithstanding any other provision of this subsection, a doctor who has not successfully completed training and testing required by this subsection for authorization to assign impairment ratings and certify MMI when there is permanent impairment may receive permission by exception to do so from the commission on a specific case basis.
   5. (5) Full authorization under this section is one of the minimum requirements to be on the Designated Doctor List (DDL). §180.21 of this title governs DDL membership requirements and procedures.

Source Note:The provisions of this §180.23 adopted to be effective March 14, 2002, 27 TexReg 1817.