1. (a) If the commission intends to take action under §180.26 (relating to Doctor and Insurance Carrier Sanctions) or action against a designated doctor under §180.21 (relating to Commission Designated Doctor List), other than in the case where a progressive disciplinary agreement under §180.26(e) was entered into, the commission shall notify the person ("person" also includes a carrier) to be sanctioned by verifiable means of the commission's intent.

   1. (1) Not later than 20 days after receiving the notice, a doctor may request a hearing at the State Office of Administrative Hearings by filing such a request with the Chief Clerk of Proceedings at the commission.
   2. (2) If no request for hearing is filed within the time allowed, the recommendation for sanction will be reviewed by the commissioners at a public meeting and a decision made. If a hearing was held, the commissioners shall review the decision of the administrative law judge (ALJ) after the hearing is held.
2. (b) If the commission modifies, amends, or changes a recommended finding of fact or conclusion of law, or order of the ALJ, the commission's final order shall state the legal basis and the specific reasons for the change.
3. (c) If the commissioners vote to impose the sanction, the commission shall notify the person by issuing an order of which describes the effects of the sanction. This order shall be delivered by verifiable means with a copy to the appropriate licensing or certification authority and, if the sanction is against a doctor, copies shall be delivered to those injured employees the commission is aware are being treated by that doctor.
4. (d) Failure to comply with the sanction may result in further sanctioning by the commission.

5. (e) A person who was sanctioned can apply to have the sanction lifted (whether through restoration of privileges or recertification) by applying in the form and manner prescribed by the commission.

   1. (1) The request shall be evaluated by the Medical Advisor and /or members of the Medical Quality Review Panel. The requestor shall be liable for the cost of the review, which may include an audit of the records of the requestor.

      1. (A) If, in the Medical Advisor's opinion, the person has all the appropriate unrestricted licenses/certifications, has overcome the conditions that resulted in sanction, and should be reinstated, the Medical Advisor shall recommend that the commissioners reinstate the doctor or restore the privileges removed or restricted by the sanction.
      2. (B) If, in the Medical Advisor's opinion, the person has not met the requirements for reinstatement or restoration of privileges, the commission shall notify the person by verifiable means of the intent to recommend to the commissioners that the sanctions not be lifted. Within 14 days after receiving the notice, a doctor may file a response that addresses the reasons given that the recommendation was to be made. The Medical Advisor shall review the response and make a final recommendation to the commissioners. A copy of the requestor's response to the commission shall be provided to the commissioners for consideration.
   2. (2) The commissioners shall consider the matter in a public meeting and shall notify the requestor by verifiable means with a copy to the appropriate licensing or certification authority. If the commissioners choose to not lift the sanction, the commissioners may include in their final decision the conditions that the sanctioned person must meet before the commission will reconsider lifting the sanctions including, but not limited to, the amount of time that the person must wait prior to rerequesting lifting the sanction.

6. (f) Notwithstanding any other provision of this section, deletion from the Approved Doctor List by the Executive Director pursuant to §180.26(b) shall be governed by this subsection.

   1. (1) Prior to deletion, the Executive Director or designee shall notify a doctor of the intention to delete the doctor and the grounds for that action.

   2. (2) Within 14 days after receiving the notice of intent, a doctor may file a response to the reasons given as grounds for the deletion with the Executive Director or designee.

      1. (A) If a response is not received by the 15th day after the date the doctor received the notice of intent, the doctor is deleted and no subsequent notice will be sent.
      2. (B) If the response is agreement, the doctor will be deleted effective on the earlier of the date the doctor agrees to the deletion or the 15th day after the date the doctor received the notice of intent and no subsequent notice will be sent.

      3. (C) If a response which disagrees with the grounds for deletion is timely received and after reviewing the response, the Executive Director or designee determines:

         1. (i) that the grounds do not exist for deletion under §180.26(b), the doctor shall be notified that he was not deleted under §180.26(b); or
         2. (ii) that the grounds for deletion do exist, the doctor shall be notified of the deletion and the notice shall identify the effective date of the deletion.
   3. (3) All notices under this subsection shall be delivered by a verifiable means.

Source Note:The provisions of this §180.27 adopted to be effective March 14, 2002, 27 TexReg 1817.