Effective September 1, 2010, a pain management clinic may not operate in Texas without obtaining a certificate from the Texas Medical Board (TMB).
The Texas Occupation Code, section 168.001, defines a “pain management clinic” as a publicly or privately owned facility for which a majority of patients are issued on a monthly basis a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.
Please visit Board rule 195 for the complete regulations.
Pain Management Clinic certificates are valid for two years. Registration forms will be mailed 60-90 days prior to the expiration date of a certificate. Certificate holders shall have a 180-day grace period from the expiration date to renew the certificate, however, the owner or operator of the clinic may not continue to operate the clinic while the permit is expired.
Certificates must be timely renewed. If a certificate is not renewed before the expiration of the grace period, the certificate will be automatically cancelled and the owner or operator of the clinic must reapply for original certification.
The physician owner/operator of a pain management clinic must register with the TMB. Certificates, once issued, are not transferable or assignable. Only the primary physician owner is required to register with the board if there is more than one physician owner of the clinic. Each clinic requires a separate certificate.
Regulations regarding the registration and operation of pain management clinics do not apply to the following settings:
- a medical or dental school or an outpatient clinics associated with a medical or dental school;
- a hospital, including any outpatient facility or clinic of a hospital;
- a hospice established under 40 TAC §97.403 (relating to Standards Specific to Agencies Licensed to Provide Hospice Services) or defined by 42 CFR §418.3;
- a facility maintained or operated by this state;
- a clinic maintained or operated by the United States;
- a nonprofit health organization certified by the board under Chapter 177 of this title (relating to Certification of Non-Profit Health Organizations);
- a clinic owned or operated by a physician who treats patients within the physician's area of specialty who personally uses other forms or treatment, including surgery, with the issuance of a prescription for a majority of the patients; or
- a clinic owned or operated by an advanced practice nurse licensed in this state who treats patients in the nurse's area of specialty and personally uses other forms of treatment with the issuance of a prescription for a majority of the patients.
Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your clinic meets one of the exemptions listed above. However, the Board does have inspection authority, and owners of clinics that have not been properly registered can be investigated.
In order that we may ensure compliance with Board Rule 195 regarding the ownership, operation and continuing medical education (CME) requirements for pain management clinics, the Board is implementing, starting January 2014, a program to inspect registered pain management clinics in the state of Texas.
The Board will provide at least 5 days’ notice prior to inspection. At, or prior to, the time of inspection each Owner/Operator of a pain management clinic will be required to provide to the following information to the Board. Please do not submit any documentation at this time.
- A copy of the current pain management clinic certificate,
- a copy of current ownership documentation,
- verification that the Medical Director is on-site at least 33% of the clinics operating hours,
- verification that the Medical Director reviews at least 33% of charts,
- a copy of the protocols for pain management,
- a copy of the written drug screen policy and compliance plan,
- documentation of quality assurance measures,
- documentation of billing records format,
- documentation of required pain management CME for medical director and all clinical staff.
Please note that the medical director of a pain management clinic must, on an annual basis, ensure that all personnel are properly licensed, and if applicable, trained to include 10 hours of continuing medical education related to pain management. This means that each registration period there is a minimum of 20 hours of formal CME in pain management that must be completed by each employee that provides medical services at the clinic.
You may view the Board Rules on pain management clinic in detail on our website under Board Rules,Chapter 195.