Clinical Competence: Quality, appropriateness, and necessity of medical decisions are clinical decisions to be based on clinical data judged by clinically competent persons. In addition, the Texas Medical Association supports legislation and regulations which stipulate that only persons with demonstrable clinical competence for the clinical decisions under review may make the review decisions concerning quality, appropriateness, and/or medical necessity of care related to a specific patient. In addition, TMA supports legislation and regulations requiring any managed care plan wishing to deny coverage or alter a clinical decision for care based on quality, appropriateness, and/or necessity of that care may do so only through clinically competent peer review of all pertinent clinical data (Substitute Res. 28AA, p 182C, A-94; reaffirmed CSE Rep. 3-A-04; reaffirmed CSE Rep. 2-A-14).
Last Updated On
October 07, 2016