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At a Glance:
Guidelines and Protocols

§ 10.83

Guidelines and Protocols

(a) Each network shall adopt treatment guidelines, return-to-work guidelines, and individual treatment protocols, which must be evidence-based, scientifically valid, outcome-focused, and designed to reduce inappropriate or unnecessary health care while safeguarding access to necessary care.

(b) An insurance carrier or network may not deny treatment for a compensable injury solely because its treatment guidelines do not specifically address the treatment or injury.

(c) A network shall, through its quality improvement program under § 10.81 of this subchapter (relating to Quality Improvement Program), assure that all treatment guidelines, return-to-work guidelines, and individual treatment protocols are made accessible to all network providers. The network shall contractually require providers to follow treatment guidelines, return-to-work guidelines and individual treatment protocols pursuant to § 10.42(b)(2) of this chapter (relating to Network Contracts with Providers).

The provisions of this § 10.83 adopted to be effective December 5, 2005, 30 TexReg 8099.

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