SECTION 180.68. Medical Quality Review Process

(a) The medical quality review process is medical case review initiated on the basis of complaints, plan-based audits, or monitoring as a result of a consent order and performed in accordance with criteria adopted under Labor Code §413.05115. The medical quality review process does not include medical case review performed for the purpose of:

(1) certification and renewal of designated doctors;

(2) performance-based oversight;

(3) administrative violations that do not require an expert medical opinion; or

(4) complaints about professionalism that do not require an expert medical opinion.

(b) A complaint must be documented in accordance with the provisions of §180.2 of this title (relating to Filing a Complaint).

(c) Nothing in this subchapter prevents referrals of complaints to another licensing or law enforcement authority.

Source Note: The provisions of this §180.68 adopted to be effective January 1, 2013, 37 TexReg 8839; amended to be effective August 22, 2023, 48 TexReg 4484