Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.19 - Collaborative Management of Glaucoma

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Purpose. The purpose of this section is to implement the mandate of the 76th
				Legislature as it relates to the Optometry Act, Texas Occupations Code Chapter
				351, regarding the minimum standards for the collaborative management of
				glaucoma.
(b) Minimum requirements.
				At a minimum, the treating ophthalmologist should follow the guidelines
				outlined in paragraphs (1) - (10) of this subsection.
(1) The ophthalmologist will confirm the
				diagnosis within 30 days of the diagnosis of glaucoma made by the optometrist.
				While the ophthalmologist may, in his or her discretion, require that the
				patient visit the ophthalmologist for a face-to-face visit, such a face-to-face
				visit is not mandated. The ophthalmologist may, at the ophthalmologist's
				discretion, rely upon the results of diagnostic tests performed originally by
				the optometrist, unless reaffirmation is needed.
(2) The ophthalmologist must communicate in
				written form the confirmation of the diagnosis within 30 days, as well as the
				refinement of the treatment plan as recommended by the optometrist.
(3) A proper medical record must be generated
				for each patient by the ophthalmologist and shall include all correspondence
				and testing results. The medical record must also include a written note made
				in the record by the ophthalmologist or a copy of the written informed consent
				demonstrating that the patient understands that he or she is participating in a
				co-management of primary open angle glaucoma.
(4) The necessity for follow-up visits will
				be at the discretion of the ophthalmologist based on the communication of the
				patient's progress by the optometrist.
(5) The ophthalmologist must report any
				irregular behavior of the optometrist to the Texas Medical Board for referral
				to the Texas Optometry Board.
(6)
				The ophthalmologist must enter into the patient's written medical records that
				the ophthalmologist has elected to enter into a co-management agreement with an
				optometrist.
(7) It is at the
				discretion of the ophthalmologist to complete a clinical skills assessment with
				each optometrist in which a co-management arrangement exists. The
				ophthalmologist will, however, receive written confirmation and documentation
				that the co-managing optometrist has completed all of the requirements of the
				Optometric Health Care Advisory Committee to obtain the designation of
				"optometric glaucoma specialist."
(8) A physician may charge a reasonable
				consultation fee for a consultation given when a patient is referred with a
				diagnosis of primary open angle glaucoma.
(9) When a physician examines a patient
				involved in a co-management consultation with a therapeutic optometrist for
				treatment of primary open angle glaucoma, the physician shall forward to the
				therapeutic optometrist, not later than the 30th day following the examination,
				a written report on the results of the examination. A physician who, for a
				medically appropriate reason, does not return a patient to the therapeutic
				optometrist, shall state in the physician's report to the therapeutic
				optometrist the specific medical reason for failing to return the
				patient.
(10) In order to enter
				into a co-management agreement with an optometrist, there must be an agreement
				between the two professionals that, following each visit, specified
				information, previously agreed upon by both the ophthalmologist and the
				optometrist, about the patient examined will be forwarded to the other
				practitioner.