Enrolled Bill Summary

            Senate Bill 544 amends the Texas Health Maintenance Organization Act to require that the basic health care services provided under an evidence of coverage include periodic health evaluations for each adult enrollee, including a health risk assessment at least once every three years and, for a female enrollee, an annual well-woman examination. The bill requires the commissioner of insurance to require a health maintenance organization (HMO) to verify that a physician's license and any other certificate the physician is required to hold is valid as of the date of initial credentialing and on the date of each recredentialing. The bill requires an HMO that conducts a site visit for the purpose of initial credentialing to evaluate certain aspects of the site.

            Senate Bill 544 amends the Insurance Code to require the commissioner to adopt a standardized form for the verification of the credentials of a physician and to mandate its use by public or private hospitals, HMOs, and preferred provider organizations.

            The bill requires the Texas State Board of Medical Examiners to study the establishment of a program for standardized credentials verification through the use of a credentialing information system and to report on its recommendations to the governor, the lieutenant governor, and the speaker of the house of representatives not later than January 1, 2003.

            Provisions of Senate Bill 544 relating to the mandatory coverage for periodic health evaluations apply only to an evidence of coverage that is delivered, issued for delivery, or renewed on or after January 1, 2002.