HBA-MPM C.S.H.B. 3216 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 3216 By: McCall Public Health 4/26/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Currently, physicians in this state are required to complete a credentialing application for each health care facility with which they seek to hold or renew an affiliation. This process applies not only to hospitals, but to nursing homes, long-term care facilities, large clinics, and managed care facilities. The credentialing effort has increased significantly as a result of health care reform and recent changes in the health care delivery and reimbursement system. Standards established by the Health Care Quality Improvement Act of 1986 and the National Committee for Quality Assurance have required an increased focus on credentialing of health care practitioners. The resulting duplication of physician credentialing activities may be unnecessary. Currently, much of the information regarding physicians is collected, verified, and stored at the Texas State Board of Medical Examiners as part of the initial licensure process. C.S.H.B. 3216 requires the Texas State Board of Medical Examiners to develop standardized forms for collecting, verifying, maintaining, and storing core credentials data and for releasing the data to health care entities or to the designated credentials verification organization. Furthermore, the bill allows appropriate entities, such as hospitals and managed care facilities, to access this information with the physician's permission to verify the core credentials the entity requires. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas State Board of Medical Examiners in SECTION 2 (Sections 7.04 and 7.07, Article 4495b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Sets forth the legislative findings and purpose of the mandatory credentials collection program established under Subchapter G, Article 4459b, V.T.C.S., as added by this Act. SECTION 2. Amends Article 4495b, V.T.C.S. (Medical Practice Act), by adding Subchapter G, as follows: SUBCHAPTER G. CREDENTIALS VERIFICATION PROGRAM Sec. 7.01. DEFINITIONS. Defines "core credentials data," "credentials verification organization," "health care entity," and "physician." Sec. 7.02. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM. (a) Requires the Texas State Board of Medical Examiners (board), in accordance with this section, to develop standardized forms and guidelines for collecting, verifying, maintaining, and storing core credentials data and for releasing the data to health care entities or to the designated credentials verification organization authorized by the physician to receive the data. Provides that once the core credentials are submitted to the board, the physician is not required to resubmit this initial data when applying for practice privileges with a health care entity. Provides that each physician is responsible for providing to the board within 30 days any corrections, updates, and modifications to the core credentials data to ensure that all credentialing data on the physician remains current. Establishes that a physician's data is on a form prescribed by the board. (b) Requires the board to develop standard forms for certain purposes. (c) Provides that any health care entity employing, contracting with, or credentialing physicians must use the board to obtain core credentials data for items the board is designated as a primary or alternate source by a national accreditation organization. Authorizes the health care entity to act through its designated credentials verification organization. (d) Provides that nothing in this section is authorized to be construed to restrict the authority of the health care entity to approve or deny an application for hospital staff membership, clinical privileges, or managed care network participation. Sec. 7.03. AVAILABILITY OF DATA COLLECTED. Requires the board to make available to a health care entity or its designated credentials verification organization all core credentials data it collects on a physician. Includes among this data corrections, updates, and modifications to the data, if authorized by the physician. Requires this information to be made available within 15 business days of receipt of the request. Sec. 7.04. DUPLICATION OF DATA PROHIBITED. Prohibits a health care entity from collecting or attempting to collect duplicate core credentials data from a physician, if the information is available from the board for items the board is designated as a primary or alternate source by a national accreditation organization. Provides that nothing in this section is authorized to be construed to restrict the right of a health care entity to request additional information not included in the core credentials data file that is necessary for the health care entity to credential the physician. Provides that additional information required by the health care entity's credentialing process is authorized to be collected from the primary sources of that information, either by the entity or its designated credentials verification organization. (b) Prohibits a Texas state agency, effective September 1, 2002, from collecting or attempting to collect duplicate core credentials data from a physician if the information is already available from the board. Provides that nothing in this section is authorized to be construed to restrict the right of a state agency to request additional information not included in the core credentials data file, but deemed necessary for the agency's specific credentialing purposes. (c) Authorizes the board, by rule, to provide exceptions to Subsections (a) and (b) if the request for a type or class of information is necessary in order for a health care entity to provide temporary privileges during the credentialing process and such information is available from another state agency. Authorizes the information to include licenser verifications. Sec. 7.05. LIABILITY. Provides that no civil, criminal, or administrative action is authorized to be instituted and prohibits any liability against any health care entity or its designated credentials verification organization because of the health care entity's or verification organization's reliance on any data obtained from the board under this subchapter. Sec. 7.06. REVIEW. Requires the board to provide a physician 15 business days to review data and request reconsideration or resolution of errors in or omissions of data collected during the credentials verification process before releasing the physician's core credentials data from its data bank for the first time. Requires any changes, comments, or clarifications made by the physician to be noted and included with the information in the core credentials data. Requires the board to notify the physician of any subsequent changes in the core credentials data when such changes are made or initiated by a person other than the physician. Authorizes a physician to request to review the data at any time after the initial release of information. Provides that such a request does not require the board to hold, release, or modify any information. Sec. 7.07. RULES. Requires the board to adopt rules necessary to develop and implement the standardized credentials verification program established by this subchapter. Sec. 7.08. CONFIDENTIALITY. Provides that the information received, collected, maintained, or stored by the board is proprietary information and is privileged and confidential and cannot be released, including by discovery or subpoena, except as provided by this subchapter or otherwise authorized by law. Sec. 7.09. USE OF INDEPENDENT CONTRACTOR. Authorizes the board to provide for the collecting, verifying, maintaining, storing, and releasing of information through an independent contractor. Requires any agreement between the board and such contractor to provide for board oversight and confidentiality and be awarded through a competitive bid process. Sec. 7.10. APPROPRIATIONS, GRANTS AND DONATIONS. Authorizes the board to receive and accept gifts, grants, donations, and any other type of funds, or things of value from any source, including the United States government and any private source, in addition to any fees paid or funds appropriated to the board. Sec. 7.11. FEES. Requires the board to charge and collect fees in amounts necessary to cover the cost of operating and administering its duties and functions under this subchapter. Authorizes the board to waive a fee for a state agency that is required to use the core credentials data and that is prohibited from collecting duplicate data by Section7.04. SECTION 3. Requires the board to implement the credentials verification program under Subchapter G, Article 4495b, V.T.C.S., as added by this Act, only if the legislature appropriates money specifically for that purpose. Authorizes, but does not require, the board to implement the credentials verification program using other appropriations, gifts, grants, or donations available for that purpose if the legislature does not appropriate money specifically for the purpose. SECTION 4. Requires the board to make available the credentials reports required by Subchapter G, Article 4495b, V.T.C.S., as added by this Act, starting no sooner than September 1, 2001. Provides that a health care entity is not required to use the board's core credentials data until such data is available from the board and the board is designated as a primary or alternate source by a national accreditation organization. SECTION 5. Effective date: September 1, 1999. SECTION 6. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute modifies the original by setting out the legislative findings and purposes in SECTION 1 of the substitute, rather than in Section 7.01, Article 4495b, V.T.C.S. The substitute moves proposed Subchapter G, Article 4495b, V.T.C.S. (Medical Practice Act), from SECTION 1 of the original to SECTION 2 of the substitute, adds new SECTIONS 3 and 4 of the substitute, and redesignates SECTION 4 of the original to SECTION 5 of the substitute. The substitute modifies the original in SECTION 2 of the substitute by modifying proposed Subchapter G, Article 4495b, V.T.C.S., as follows: The substitute entitles the subchapter "Credentials Verification Program." The substitute removes text from the proposed subchapter which would have created the Credentials Verification Council (council). The council would have developed standardized forms and guidelines to administer the collecting, verifying, maintaining, storing, and releasing to health care entities of information relating to physician credentials. Instead, the substitute requires the Texas State Board of Medical Examiners (board) to develop a standardized credentials verification program. This requirement would have appeared in the original, but with the removal of the creation of the council, many requirements that would have involved the council now pertain solely to the board. As a result of the removal of the council, the substitute deletes the text of proposed Sections 7.02, 7.03, and 7.10. The substitute adds new text for Section 7.09 and redesignates proposed Sections 7.04, 7.05, 7.06, 7.07, 7,08, 7.09, 7.11, 7.12, 7.13, and 7.14 to Sections 7.01, 7.02, 7.03, 7.04, 7.05, 7.06, 7.07, 7.08, 7.10, and 7.11. The substitute modifies Section 7.01, as redesignated from proposed Section 7.04, to redefine "core credentials data," "health care entity," and " physician," to change the name of a term from "credentialing verification organization" to "credentials verification organization" and to redefine it, and to delete the terms "board," "drug enforcement administration certification," "hospital affiliations," "licensure core credentials data," "national accrediting organization," "national accrediting organization," "primary source verification," "professional training," "recredentialing," "secondary source verification," and "specialty board certification." The substitute modifies Section 7.02, as redesignated from proposed Section 7.05, in Subsection (a) to provide that physicians's data is on a form prescribed by the board. The substitute modifies Subsection (c) to provide that any health care entity that credentials physicians, rather than allows physicians to treat its patients, must use the board to obtain core credentials data for items the board is designated as a primary or alternate source by a national accreditation organization. The substitute deletes the text of proposed Subsection (d), which would have provided that nothing in this section could be construed to restrict access to the National Practitioner Data Bank by the board, the council, or any health care entity. The substitute redesignates proposed Subsection (e) to Subsection (d) and makes conforming and nonsubstantive changes throughout the section. The substitute modifies Section 7.03, as redesignated from proposed Section 7.06, to add a requirement that all core credentials data to be made available within 15 business days of receipt of the request. The substitute makes conforming and nonsubstantive changes. The substitute modifies Section 7.04, as redesignated from proposed Section 7.07, to add a provision in Subsection (a) that prohibits a health care entity from collecting or attempting to collect duplicate core credentials data from a physician if the information is available from the board for items the board is designated as a primary or alternate source by a national accreditation organization. The substitute deletes rulemaking authority expressly delegated to the council in Subsection (a). The substitute changes the date referenced in Subsection (b) from July 1, 2002, to September 1, 2002, regarding a state agency's duplication of core credentials data. The substitute adds Subsection (c), which authorizes the board, by rule, to provide exceptions to Subsections (a) and (b) if the request for a type or class of information is necessary in order for a health care entity to provide temporary privileges during the credentialing process and such information is available from another state agency. Subsection (c) also authorizes the information to include licenser verifications. The substitute makes conforming and nonsubstantive changes throughout the section. The substitute modifies Section 7.05, as redesignated from proposed Section 7.08, to add a provision that no civil, criminal, or administrative action may be instituted and no liability shall be against any health care entity's designated credentials verification organization because of its reliance on data obtained by the board. The substitute modifies Section 7.06, as redesignated from proposed Section 7.09, to require the board to provide a physician 15, rather than 30, business days to review the data and request reconsideration of the data before releasing the physician's core credentials for the first time. The substitute requires any changes, comments, or clarifications made by the physician to be noted and included with the information in the core credentials data. The substitute requires the board to notify the physician of any subsequent changes in the core credentials data when such changes are made or initiated by a person other than the physician. The substitute authorizes a physician to request to review the data at any time after the initial release of information and provides that such a request does not require the board to hold, release, or modify any information. The substitute makes nonsubstantive changes. The substitute modifies Section 7.07, as redesignated from proposed Section 7.11, to require the board, rather than the board in conjunction with the council, to adopt rules. The substitute modifies Section 7.08, as redesignated from proposed Section 7.12, to provide that the information maintained by the board is proprietary information. The substitute provides that the information cannot be released, including by discovery or subpoena, except as provided by this subchapter or otherwise authorized by law. The original would have provided that this information is not subject to the Open Records Law in Chapter 552 (Public Information), Government Code. The substitute adds new Section 7.09 to authorize the board to provide for the collecting, verifying, maintaining, storing, and releasing of information through an independent contractor. Section 7.09 requires any agreement between the board and such contractor to provide for board oversight and confidentiality and be awarded through a competitive bid process. The substitute modifies Section 7.10, as redesignated from proposed Section 7.13, to make conforming and nonsubstantive changes. The substitute modifies Section 7.11, as redesignated from proposed Section 7.14, to add a provision that authorizes the board to waive a fee for a state agency that is required to use the core credentials data and that is prohibited from collecting duplicate data. The substitute makes conforming and nonsubstantive changes. The substitute adds new SECTION 3 to require the board to implement the credentials verification program under Subchapter G, Article 4495b, V.T.C.S., as added by this Act, only if the legislature appropriates money specifically for that purpose and authorizes the board to implement the credentials verification program using other appropriations, gifts, grants, or donations available for that purpose if the legislature does not appropriate money specifically for that purpose. The substitute adds new SECTION 4 to require the board to make available the credentials reports required by Subchapter G, Article 4495b, V.T.C.S., as added by this Act, starting no sooner than September 1, 2001, and provides that a health care entity is not required to use the board's core credentials data until such data is available from the board and the board is designated as a primary or alternate source by a national accreditation organization. SECTIONS 2, 3 and 5 of the original, which are now deleted, would have set forth requirements for the council.