SRC-JJJ, JXG C.S.S.B. 1207 76(R)BILL ANALYSIS
Senate Research CenterC.S.S.B. 1207
By: Cain
Health Services
4/29/1999
Committee Report (Substituted)
DIGEST
Currently, under the Medical Practice Act of Texas, physicians are
licensed. The Medical Practice Act assures that physicians who are seeking
licensure in Texas by way of endorsement, or original licenses that are
reviewed, examined, and evaluated according to the appropriate standards.
The Texas Board of Medical Examiners (board) is the state agency created by
the legislature to carry out the constitutional mandate of Section 31,
Article XVI, Texas Constitution, which requires the legislature to pass
laws for malpractice. The mission of the board is to assure the safety of
its citizens through the appropriate regulation of physicians who practice
medicine in Texas. The Medical Practice Act has been amended to adapt to
the changing social, educational, and economic times, since its inception.
C.S.S.B. 1207 would consolidate relevant sections of the Medical Practice
Act, by creating coherent sections with all the necessary provisions for
licensure of physicians.
PURPOSE
As proposed, C.S.S.B. 1207 sets forth licensure requirements for physicians.
RULEMAKING AUTHORITY
Rulemaking authority is granted to the Texas Board of Medical Examiners in
SECTION 2 (Sections 3.01(b) and (m); 3.03(b),(c), and (f); 3.04(3) and
(c)(6); 3.05(e) and (g); Article 4495(b), V.T.C.S.) of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 2.09, Article 4495b, V.T.C.S., (Medical Practice
Act), by amending Subsections (d), (h), (k), and (t) and adding Subsection
(bb), to require the record to show whether applicants were denied or
licensed. Requires a certified copy of those permanent records, with the
hand or seal of the executive director, rather than secretary treasurer, of
the Texas State Board of Medical Examiners (board), to be admitted in
evidence in all courts. Authorizes the board to submit to the Department of
Public Safety a complete set of fingerprints of every applicant for a
license. Requires the board to place all receipts collected under authority
of this Act. Requires the board on request of a licensee issue
certification of state board examination grades to the Federation of State
Medical Boards of the United States and charge a reasonable fee for the
issuance. Requires the executive director of the board to file a surety
bond with the board. Requires the bond to be in an amount no less than
$10,000, be in compliance with the insurance laws of the state, and be
payable to the state for the use of the state, if the executive director
does not faithfully discharge the duties of the office. Requires the board
to pay the premium on the bond. Deletes text regarding license cancellation
or suspension. Deletes text regarding fees received put into the medical
licensing fund. Makes conforming changes.
SECTION 2. Amends Sections 3.01-3.05, Article 4495b, V.T.C.S., as follows:
Sec. 3.01. New heading: ANNUAL REGISTRATION OF PHYSICIANS. (a) Requires
all persons now lawfully qualified to practice medicine in this state, or
who are hereafter licensed for the practice of medicine by the board, to
register annually as practitioners with the board. Requires the initial
annual registration permit to be issued with the license.
(b) Requires the annual registration permit fee as established by board
rule to apply to all physicians licensed by the board, whether or not they
are practicing within the borders of this state, except retired physicians
as provided by rules of the board.
(c) Provides that a physician licensed by the board whose only practice is
voluntary charity care is exempt from the annual registration permit fee as
provided by rules of the board.
(d) Requires the board to mail an annual registration permit renewal
application to each practitioner at the practitioner's last known address
according to the records of the board at least 30 days prior to the
expiration date of the annual registration permit.
(e) Requires the board to provide for a 30-day grace period for renewing
the annual registration permit from the date of the expiration of the
annual registration permit.
(f) Authorizes a licensee to renew the annual registration permit by
submitting to the board, on or before the expiration date of the annual
registration permit, the required renewal application and renewal fee.
Requires each annual registration permit renewal application to include the
name and mailing address of the licensee, the place or places where the
licensee is engaged in the practice of medicine, and other necessary
information prescribed by the board.
(g) Requires the renewal application to include a description of any
investigations the licensee knows are in progress and of any sanctions
imposed by or disciplinary matters pending in the state, district,
territory, country, or service, if the licensee is licensed for the
practice of medicine in another state, the District of Columbia, a
territory of the United States, Canada, any other country, or the uniformed
services of the United States.
(h) Requires on receipt of a renewal application and all required fees,
the board, after ascertaining, either from the records of the board or from
other sources considered by it to be reliable, that the applicant is a
licensed practitioner of medicine in this state, to issue to the licensee
an annual registration permit certifying that the licensee has filed the
renewal application, has paid the annual registration permit fee for the
year in question, and has completed the requirements for annual
registration.
(i) Authorizes a licensee to renew his or her annual registration permit
by submitting to the board the required renewal application, renewal fee,
and a $50 penalty fee, if a licensee's annual registration permit has been
expired for 90 days or less.
(j) Authorizes the licensee to renew the annual registration permit by
submitting to the board the required renewal application, renewal fee, and
a $100 penalty fee, if a licensee's annual registration permit has been
expired for longer than 90 days but less than one year.
(k) Provides that the license is considered to have been canceled, unless
an investigation is pending, and the licensee may not renew the annual
registration permit, if a licensee's annual registration permit has been
expired for one year or longer.
(l) Authorizes each physician whose license is considered canceled to
obtain a new license by submitting to reexamination and complying with the
requirements, fees, and procedures for obtaining a license. Authorizes the
board to issue a new license without examination to a person whose license
is considered canceled for less than two years.
(m) Authorizes the board, by rule, to adopt a system under which annual
registration permits expire on various dates during the year. Requires
annual registration permit fees to be prorated, for the year in which the
expiration date is changed. Provides that the total annual registration
permit fee is payable, on renewal of the annual registration on the new
expiration date.
(n) Requires the filing of the renewal application, the payment of the
required fees, and issuance of the permit to not entitle the holder to
practice medicine in Texas, unless the holder has been previously licensed
as a practitioner by the board, as prescribed by law, and the license to
practice medicine is in full force and effect. Prohibits the annual
registration permit required by this Act from being treated as evidence
that the holder is lawfully entitled to practice medicine, in any
prosecution for the unlawful practice of medicine.
(o) Provides that practicing medicine as defined in this Act without an
annual registration permit for the current year as provided in this Act has
the same force and effect as and is subject to all penalties of practicing
medicine without a license. Deletes text regarding registration with the
board, licenses, renewing licenses, and fees. Deletes text regarding
unlawful practice of medicine, annual registration fee, and application for
licensure.
Sec. 3.02. New heading: PHYSICIAN IN TRAINING PERMITS. Authorizes
physicians not otherwise licensed by the board who are participating in
graduate medical education training programs approved by the board to be
issued physician in training permits as provided by rules of the board.
Provides that this permit does not authorize the performance of medical
acts except as the acts are performed as part of graduate medical education
training programs and under the supervision of a licensed practitioner of
medicine. Provides that the board has jurisdiction to discipline a
physician whose physician in training permit has expired if the violation
of the law occurred during the time that the permit was valid. Requires the
permit to be executory and the board to retain jurisdiction, if an
investigation is open when the permit expires. Deletes text regarding
application for receipt or renewal fees, and authorizing the board to adopt
a system for expired registration dates.
Sec. 3.03. New heading: LICENSURE OF PHYSICIANS. (a) Authorizes the board
to grant a license to practice medicine to any physician who qualifies
under this Act.
(b) Requires an application for a license to be in writing and on forms
prescribed by the board. Authorizes the board to allow or require
applicants, by board rule, to use the Credentials Verification Service
offered by the Federation of State Medical Boards of the United States.
(c) Requires the application forms to be accompanied by all fees,
documents, and photographs required by board rule.
(d) Requires applicants for a license to subscribe to an oath in writing
before an officer authorized by law to administer oaths. Provides that the
written oath is part of the application.
(e) Provides that an applicant is not eligible for a license if certain
conditions exist.
(f) Requires an applicant to present satisfactory proof to the board that
each medical school attended is substantially equivalent to a Texas medical
school as determined by board rule.
(g) Requires an applicant who is a graduate of a medical school that is
located outside the United States and Canada to present satisfactory proof
to the board that the applicant meets certain requirements.
(h) Requires all medical or osteopathic medical education received by the
applicant in the United States to be accredited by an accrediting body
officially recognized by the United States Department of Education as the
accrediting body for medical education leading to the doctor of medicine
degree or the doctor of osteopathy degree in the United States. Provides
that this subsection does not apply to postgraduate medical education or
training.
(i) Authorizes an applicant who is unable to comply with the requirements
of Subsection (h) of this section to be eligible for an unrestricted
license if the applicant meets certain conditions.
(j) Requires the executive director to review each application for
licensure and to recommend to the board all applicants eligible for
licensure. Requires the executive director to also report to the board the
names of all applicants determined to be ineligible for licensure,
together with the reasons for each recommendation. Authorizes an applicant
deemed ineligible for licensure by the executive director to request review
of such recommendation by a committee of the board within 20 days of
receipt of such notice, and the executive director to refer any application
to the committee for a recommendation concerning eligibility. Authorizes
the committee to refer any application for determination of eligibility to
the full board. Provides that if the committee finds the applicant
ineligible for licensure, such recommendation, together with the reasons
for the recommendation, to be submitted to the board unless the applicant
requests a hearing with 20 days of receipt of notice of the committee's
determination. Requires the hearing to be before an administrative law
judge of the State Office of Administrative Hearings and to comply with
Chapter 2001, Government Code, and the rules of the State Office of
Administrative Hearing (office) and the board, if the applicant requests a
hearing. Requires the board, after receiving the administrative law judge's
proposed findings of fact and conclusions of law, determine the eligibility
of the applicant for licensure. Requires a physician whose application for
licensure is denied by the board to receive a written statement containing
the reasons for the board's action.
(k) Authorizes the examination questions to be used in the future,
examinations other than the one taken by the person requesting it, and
deliberations and records relating to the professional character and
fitness of applicants are exempted from the open meeting law, Chapter 551,
Government Code, and the public information law, Chapter 552, Government
Code.
(l) Provides that all reports received or gathered by the board on each
applicant are confidential and are not subject to disclosure under the
public information law, Chapter 552, Government Code. Authorizes the board
to disclose such reports to appropriate licensing authorities in other
states. Requires the board to report all licensure actions to appropriate
licensing authorities in other states and to the Federation of State
Medical Boards of the United States.
(m) Authorizes the board to require applicants to comply with other
requirements that the board considers appropriate, in addition to the
requirements prescribed by this Act. Deletes text regarding payment of a
fee by the applicants and the requirements of an application for license.
Sec. 3.04. New heading: QUALIFICATIONS OF LICENSEES. Requires an applicant
to present satisfactory proof to the board that the applicant is of good
professional character and has not violated Section 3.08 of this Act; and
has completed the entire primary, secondary, and premedical education
required in the country of medical school graduation, if the medical school
is located outside the United States or Canada; or substantially equivalent
courses as determined, by board rule; is a graduate of a medical school
located inside the United States or Canada and approved by the board who
has successfully complete one year of graduate medical training approved by
the board in the United States or Canada or is a graduate of a medical
school located outside the United States or Canada who has successfully
completed three years of graduate medical training approved by the board in
the United States or Canada; has successfully passed within three attempts
an examination accepted or administered by the board; and has successfully
passed a Texas medical jurisprudence examination as determined by board
rule. Deletes text regarding applications for examinations and licensure
requirements for applicants. Makes conforming changes and nonsubstantive
changes.
Sec. 3.05. New heading: EXAMINATIONS ACCEPTED OR ADMINISTERED. (a)
Authorizes the board to administer or accept certain examinations for
licensure as determined by rule.
(b) Requires all examinations used by the board for licensure to practice
medicine to be in writing. Requires applicants who wish to request
reasonable accommodations due to a disability to submit the request on
filing the application.
(c) Requires examinations to include subjects generally required of
candidates for the degree of doctor of medicine or doctor of osteopathy
conferred by schools in Texas.
(d) Requires the board to administer the Texas medical jurisprudence
examination to all applicants.
(e) Authorizes the minimum passing grade for all examinations used by the
board to be determined, by rule.
(f) Provides that examinations administered to evaluate basic medical
knowledge and clinical competency to be prepared by a national testing
service or the board and validated by qualified independent testing
professionals.
(g) Authorizes all questions, answers, and grades to be preserved for one
year as the board may direct, by rule.
(h) Requires all applicants to be given due notice of the date and place
of the examination if administered by the board.
(i) Requires each examinee to be notified of the results of the
examination, within 120 days after the day on which an examination is
administered by the board. Requires the board to notify each examinee of
the results of the examination no later than 30 days after the date the
board receives the results from the testing service, if an examination is
graded or reviewed by national testing service.
(j) Requires all parts of certain medical examiner's examinations, except
as provided by Subsection (m), on or after June 1, 1985, and the United
States Medical Licensing Examination to be passed within seven years.
Deletes text regarding examination requirements. Makes conforming changes.
(k) Requires an applicant to pass each part of the examination within
three attempts, except that an applicant who has passed all but one part
may take the remaining part of the examination one additional time.
(l) Sets forth provisions by which an applicant is considered to have
satisfied the requirements of this section, notwithstanding Subsection (k).
(m) Requires applicants who are graduates of certain dual doctoral degrees
to pass each part of the examination not later than the second anniversary
of the date the applicant was awarded a doctor of medicine degree or doctor
of osteopathy degree. Deletes text regarding examination requirements.
Makes conforming changes.
SECTION 3. Amends Section 3.10, Article 4495b, V.T.C.S., to require all
receipts collected by the board to be placed in the state treasury as
provided by the General Appropriations Act, this Act, or other applicable
laws, to be spent only for the enforcement of this Act, the prohibition of
the unlawful practice of medicine, the dissemination of information to
prevent the violation of the laws, and the prosecution of those who violate
the laws. Authorizes all distributions to be made only on written approval
of the executive director of the board or his designated representative.
Prohibits the board from setting, charging, collecting, receiving, or
depositing fees in excess of certain amounts. Authorizes the board to set
and collect a sales charge for making copies of records in the office of
the board and for any material published by the board. Provides that the
financial transactions of the board are subject to audit by the state
auditor in accordance with Chapter 321, Government Code. Requires the board
to file annually with the governor and the presiding officer of each house
of the legislature a complete and detailed written report accounting for
all funds received and disbursed by the board during the preceding fiscal
year. Requires the annual report to be in the form and reported in the
time provided by the General Appropriations Act. Deletes text regarding
the medical registration fund, depositing certain fees, and a written
report accounting for all fund disbursed to the board.
SECTION 4. Amends Section 3.11A, Article 4495b, V.T.C.S., as follows:
Sec. 3.11A. New heading: SURCHARGE; DISPOSITION. (a) Requires an
additional $200 surcharge to apply to certain fees regarding licensing and
registration.
(b) Requires a certain surcharge, rather than fee, to be deposited to the
foundation school fund and general revenue fund. Deletes text regarding
certain disposition of fees.
SECTION 5. Repealer: Section 2.10, Chapter 36, Acts of the 73rd
Legislature, Regular Session, 1993 (Creation of Funds)
Repealer: Section 3.0305, Article 4495b, V.T.C.S. (Temporary
License for Out-of- State Practitioners)
Repealer: Section 3.031, Article 4495b, V.T.C.S. (Temporary
reciprocal license for physicians employed by Texas Department
of Mental Health and Mental Retardation)
SECTION 6. Emergency clause.
Effective date: upon passage.
SUMMARY OF COMMITTEE CHANGES
SECTION 2.
Amends Section 3.01(k), Article 4495b, V.T.C.S., to provide that the
license is considered to have been canceled, unless an investigation is
pending, and the licensee may not renew the annual registration permit, if
a licensee's annual registration permit has been expired for one year or
longer.
Amends Section 3.03(e), Article 4495b, V.T.C.S., to provide that an
applicant is not eligible for a license if certain conditions exist,
including an applicant holding a license that is currently restricted,
canceled, suspended, or revoked for cause by a state of the United States,
a province of Canada, or a uniform service of the United States. Deletes
proposed Section 3.03(e)(1). Makes conforming changes.
Amends Section 3.05, Article 4495b. V.T.C.S., by amending Subsection (j)
and adding a new Subsections (k), (l), and (m), to set forth limits
regarding an applicant's opportunity to take and pass certain medical
examinations. Sets forth provisions by which an applicant is considered to
have satisfied the requirements of this section, notwithstanding Subsection
(k). Requires applicants who are graduates of certain dual doctoral degrees
to pass each part of the examination not later than the second anniversary
of the date the applicant was awarded a doctor of medicine degree or doctor
of osteopathy degree. Deletes text regarding examination requirements.
SECTION 3.
Amends Sections 3.10(a) and (b), Article 4495b, V.T.C.S., to require all
receipts collected by the board to be placed in the state treasury as
provided by the General Appropriations Act, this Act, or other applicable
laws, to be spent only for the enforcement of this Act, the prohibition of
the unlawful practice of medicine, the dissemination of information to
prevent the violation of the laws, and the prosecution of those who violate
the laws. Prohibits the board from setting, charging, collecting,
receiving, or depositing fees in excess of certain amounts.
SECTION 4.
Amends Section 3.11A(a), Article 4495b, V.T.C.S., to require an additional
$200 surcharge to apply to certain fees regarding licensing and
registration.