28 Tex. Admin. Code § 12.204 - Prohibitions of Certain Activities and Relationships of Independent Review Organizations and Individuals or Entities Associated with Independent Review Organizations
(a) An IRO must
not set or impose any notice or other review procedures that are contrary to
the requirements of the health insurance policy or health benefit plan unless
those requirements are set out in this chapter or Texas law.
(b) An IRO may not permit or provide
compensation or anything of value to its physicians or providers that would
affect, directly or indirectly, an independent review decision.
(c) An IRO may not operate out of the same
office or other facility as another IRO.
(1)
This prohibition extends to the shared use by IROs of the resources and staff
that comprise an office, including office space, telephone and fax lines,
electronic equipment, supplies, and clerical staff.
(2) This prohibition does not extend to the
use of subcontractor services or personnel employed by or under contract with
the IRO to perform independent review.
(d) An individual who serves as an officer,
director, manager, executive, or supervisor of an IRO may not serve as an
officer, director, manager, executive, supervisor, employee, agent, or
independent contractor of another IRO.
(e) An individual or entity may not own more
than one IRO.
(f) An individual may
not own stock in more than one IRO.
(g) An individual may not serve on the board
of more than one IRO.
(h) An
individual who has served on the board of an IRO that has had its certificate
of registration revoked for cause may not serve on the board of another IRO
earlier than the fifth anniversary of the date the revocation
occurred.
Notes
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