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ADVISORY 2003-03

SUBJECT: Approved Doctor List Training and Application Requirements

The purpose of this advisory is to provide information to assist doctors with the new Approved Doctor List (ADL) training and application requirements. The current ADL will no longer exist after August 31, 2003. Doctors must complete the application process and obtain Commission approval or temporary exception to the requirement to be on the ADL by September 1, 2003, in order to continue to provide and be reimbursed for health care in the Texas workers' compensation system without interruption. As of September 1, 2003, the ADL will consist only of doctors who have been approved through the new application process or granted a temporary exception to the requirement to be on the ADL. For the continuity of care to injured employees, it is imperative that doctors train and apply for the new Commission Approved Doctor List as soon as possible.

Non-Medical Management Designation:
The Commission has identified three types of medical practice in the non-medical management designation category: Anesthesiology-Surgical Only (excludes pain management), Radiology, and Pathology. The Commission has proposed amendments to Rules 180.20, 180.21 and 180.23 to modify training requirements and address the procedures for inclusion on the ADL with a non-medical management designation. At this time, the Commission will insert a shorter training module within the online application itself, to allow doctors who wish to be on the ADL with this non-medical management designation to take training relevant to their role and to immediately continue with the online application form. The applicant must select Level 1 on the application, and designate in the appropriate place on the application that the doctor's practice does not include on-going medical management of treatment. Doctors who qualify for the shorter training module within the application is limited to those whose practice does not include ongoing medical management of injured employees. The Commission may monitor the performance of these types of practitioners and modify the required training in the future as necessary.

Temporary Exception Designation:
With the proposed amendments to Rules 180.20, 180.21, and 180.23 the Commission may utilize its statutory authority to grant exceptions to the requirement to be on the ADL to ensure that employees have access to health care and that insurance carriers have access to evaluation of health care. Temporary exceptions to the requirement that a doctor be on the ADL may be granted while an ADL application is being reviewed. The list of doctors who receive a temporary exception to the requirement to be on the ADL will be posted on the Commission's website. Once the Commission has completed reviewing the ADL application, the status will be changed from exception status to an approved or denied status.

A temporary exception does not constitute "being on the ADL," "approval to be on the ADL," or "denial of an application to be on the ADL." In addition, the temporary exception from being on the ADL is not a reason for an insurance carrier to withhold or to deny reimbursement for medically necessary treatment and services provided to employees. A temporary exception will allow a doctor to be reimbursed in accordance with the Texas Workers' Compensation Act and Commission Rules, for directly or indirectly providing reasonable and necessary health care (other than emergency or immediate post-injury medical care) or other medical services (such as peer reviews or other evaluations).

Signed on this 7th day of March, 2003

Richard F. Reynolds, Executive Director

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