Sec. 4201.455. PERSONNEL. (a) Personnel who are employed by or under contract with a specialty utilization review agent to perform utilization review must be appropriately trained and qualified and meet the requirements of this chapter and other applicable law of this state, including applicable licensing laws.
(b) Personnel who obtain oral or written information directly from a physician or other health care provider must be a nurse, physician assistant, or other health care provider of the same specialty as the agent and who are licensed or otherwise authorized to provide the specialty health care service by a state licensing agency in the United States.
(c) This section does not require personnel who perform only clerical or administrative tasks to have the qualifications prescribed by this section.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742), Sec. 3.08, eff. September 1, 2019.
Structure Texas Statutes
Title 14 - Utilization Review and Independent Review
Chapter 4201 - Utilization Review Agents
Subchapter J. Specialty Utilization Review Agents
Section 4201.452. Inapplicability of Certain Other Law
Section 4201.453. Utilization Review Plan
Section 4201.454. Utilization Review Under Direction of Provider of Same Specialty
Section 4201.456. Opportunity to Discuss Treatment Before Adverse Determination