Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is seeking input from workers’ compensation system participants for the 2019 Medical Quality Review Annual Audit Plan (Annual Plan).
The Annual Plan sets the priorities for the Medical Quality Review Panel (MQRP) audits during the upcoming year per Section IV of the Annual Plan. This includes the scope, methodology, selection criteria, and program area responsibilities described in the Medical Quality Review Process (Process). Information about the Process and the proposed Annual Plan is available on the TDI website.
The medical advisor is responsible for developing the Annual Plan, which is adopted by the Commissioner of Workers’ Compensation. The medical advisor evaluates Annual Plan suggestions from system participants using the following criteria:
- Does the suggested audit relate to a statutory responsibility of the medical advisor or the MQRP under Texas Labor Code §§413.0511 and 413.0512? (e.g., the quality of health care provided by doctors or other health care providers treating injured employees; or the quality and timeliness of decisions made by utilization review agents, insurance carriers, designated doctors or independent review organizations)
- Is the administrative data to select system participants for the audit available to DWC, or is it easily obtained and reasonable to complete the audit?
- Does DWC have adequate resources to complete the audit within the calendar year?
Suggestions can be submitted for the proposed Annual Plan by email to OMA@tdi.texas.gov by 5 pm Central time on Friday, November 30, 2018.
If you have any questions, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov