How Texas Pain Management Clinics Can Avoid TMB Compliance Audits

Complaints against pain management clinics (PMCs) go to the Texas Medical Board (TMB) for investigation, evaluation, and potential disciplinary proceedings. Likewise, poor scores on TMB compliance audits can lead to disciplinary action. Suppose you or your facility is facing a disciplinary complaint before the Board.

Pain Management Clinics Under Texas Law

Texas law requires all PMCs to register with the TMB. PMCs primarily treat patients with chronic pain. According to the TMB, a PMC is defined as a “publicly or privately owned facility for which a majority of patients are issued every month a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.” PMCs must renew their registrations with the TMB every two years. 

Some types of facilities and clinics are exempt from TMB registration. For instance, practices that only treat pain patients as part of cancer care or provide only palliative care, hospice, or other end-of-life care are exempt from certification requirements as PMCs.

Audits of PMCs

22 Tex. Admin. Code Sec. 195.5 outlines audits, inspections, and investigations of PMCs. Audits are non-disciplinary reviews by the TMB that are:

  • Conducted as an off-site document review; and
  • Initiated by a TMB subpoena request for documents as necessary to determine or verify:
    • exemption from application of Chapter 168 of the Act;
    • need to certify as a PMC; or
    • no certification requirement.

During an audit, the TMB reviews the records of 30 patients of the PMC. These records shall consist of a combination of new patients seen in one of the last two calendar months and established patients seen in the previous six calendar months, with a minimum of ten records for each type. The relevant portions of the patient records reviewed include the following:

  • the initial visits
  • the last two office visits
  • referrals
  • procedures notes/logs
  • consultation requests
  • consult notes
  • prior authorization records, if any

However, requested documents may also include those used to verify personnel training, qualifications, and general compliance with the state laws and TMB rules applicable to PMCs. 

Upon completion of the audit, the TMB will issue a notice of determination to the audited PMC owner. This notice will specify any deficiencies and, if necessary, any corrective actions the PMC must take, including a requirement to apply for certification.  

Gold Designated Practices

Under 22 Tex. Admin. Code Sec. 195.2, PMCs may apply with the TMB to be Gold Designated Practices. The advantage of obtaining a Gold Designation Practice status is that it allows a PMC to avoid audits or investigations for five years. To apply for this status, PMCs must complete the following actions:

  • Complete a TMB-approved application form;
  • Provide a Medical Home Agreement, written collaborative, coordinated care agreement, or memorandum of understanding to provide management and treatment of pain that prescribes measures it provides and may be used for the reduction of pain;
  • Either:
    • Meet the standards for exemption under Section 168.002(7) of the Act, including the clinic is operated by a majority of physicians who currently hold or previously held ABMS or AOA Board certification or subspecialty certification in pain management; and
      • Have a majority of physicians perform or properly supervise delegates in providing other forms of treatment besides qualifying pain management prescriptions to a majority of the patients at the clinic;
      • The clinic’s providers utilize a Medical Home Agreement signed by the primary prescriber and the patient; or
      • Have a written collaborative, coordinated care agreement or a memorandum of understanding with the patient’s primary physician for treating and managing the patient; or
    • Be a Certified PMC that is operated by physicians who previously held an ABMS or AOA Board-certification or sub-specialty in pain management or hold an ABMS or AOA Board-certification in an area that is eligible for a pain management subspecialty; and
      • Have a Medical Home Agreement signed by the primary prescriber and the patient; or
      • A written collaborative, coordinated care agreement or memorandum of understanding providing that each physician who prescribes qualifying prescriptions will consult with a pain specialist for the patient.

The TMB conducts the qualifying audit as an off-site document review. The Gold Designation Practice status is good for five years. During the five-year “Gold Designation Practice” period, the TMB will conduct no further audits or inspections except under the following circumstances:

  • A complaint is received or initiated by the Board concerning the operation of the clinic or operators at the clinic;
  • The clinic changes location; or
  • The clinic’s ownership structure changes to a majority of new owners.

Practices that only treat pain patients as part of cancer care or provide only palliative care, hospice, or other end-of-life care do not qualify for the “Gold Designated Practice” status.


Navigating the regulatory landscape surrounding pain management clinics (PMCs) in Texas demands a comprehensive understanding of state laws and regulatory requirements outlined by the Texas Medical Board (TMB). As PMCs play a vital role in addressing chronic pain among patients, compliance with TMB regulations is paramount to ensure the quality and safety of patient care. The TMB conducts audits and investigations to evaluate PMC compliance with registration requirements, with deficiencies potentially leading to disciplinary action. However, PMCs can obtain Gold Designated Practice status, providing a reprieve from audits and investigations for five years, contingent upon meeting specific criteria outlined by the TMB. While the designation offers a valuable opportunity for PMCs to focus on patient care without regulatory interruptions, it underscores the importance of continued adherence to TMB standards to maintain the integrity of pain management practices. Thus, PMCs must remain vigilant in regulatory compliance to uphold the highest standards of patient care and professional ethics in pain management.

Contact Bertolino LLP Today for Legal Assistance 

Do not hesitate to get legal assistance if facing potential disciplinary action against your medical license. Retaining the services of legal counsel from the beginning of any TMB investigation concerning your pain clinic can be key to a more successful outcome in your case. Contact a Texas medical license defense attorney immediately if you receive or anticipate receiving notice of disciplinary proceedings.

Call or text (512) 476-5757 or complete a Case Evaluation form