By McCall H.B. No. 3216
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the standardization of credentialing of physicians.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. The legislature recognizes that an efficient and
1-5 effective credentialing program helps to ensure access to quality
1-6 health care and also recognizes that physician credentialing
1-7 activities have increased significantly as a result of health care
1-8 reform and recent changes in health care delivery and reimbursement
1-9 systems. Moreover, the resulting duplication of physician
1-10 credentialing activities is unnecessarily costly and cumbersome for
1-11 both the practitioner and the entity granting practice privileges.
1-12 Therefore, it is the intent of the legislature that a mandatory
1-13 credentials collection program be established which provides that,
1-14 once a physician's core credentials data are collected, validated,
1-15 maintained, and stored they need not be collected again.
1-16 SECTION 2. The Medical Practice Act (Article 4495b, Vernon's
1-17 Texas Civil Statutes) is amended by adding Subchapter G to read as
1-18 follows:
1-19 SUBCHAPTER G. CREDENTIALS VERIFICATION PROGRAM
1-20 Sec. 7.01. DEFINITIONS. In this subchapter:
1-21 (1) "Core credentials data" means the following data:
1-22 (A) identity information;
1-23 (B) all professional education;
1-24 (C) all professional training;
2-1 (D) licensure from Texas and other states or
2-2 jurisdictions of the United States; and
2-3 (E) Educational Commission for Foreign Medical
2-4 Graduates certification.
2-5 (2) "Credentials verification organization" means any
2-6 organization certified or accredited as a credentials verification
2-7 organization for the express purpose of collecting, verifying,
2-8 maintaining, storing, and providing to health care entities a
2-9 health care practitioner's verified credentials data, including all
2-10 corrections, updates, and modifications to such data, as authorized
2-11 by the physician. For the purposes of this subdivision,
2-12 "certified" or "accredited" shall include nationally recognized
2-13 accreditation organizations.
2-14 (3) "Health care entity" means:
2-15 (A) any health care facility or other health
2-16 care organization licensed or certified to provide approved medical
2-17 and allied health services in Texas;
2-18 (B) any entity licensed by the Texas Department
2-19 of Insurance as a prepaid health care plan or health maintenance
2-20 organization or as an insurer to provide coverage for health care
2-21 services through a network of providers; or
2-22 (C) any health care provider entity accepting a
2-23 delegated credentialing function from a health maintenance
2-24 organization.
2-25 (4) "Physician" means any person licensed or applying
2-26 for licensure under this Act based on the person's doctor of
2-27 medicine or doctor of an osteopathy degree.
3-1 Sec. 7.02. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.
3-2 (a) In accordance with the provisions of this section, the board
3-3 shall develop standardized forms and guidelines for collecting,
3-4 verifying, maintaining, and storing core credentials data and for
3-5 releasing the data to health care entities or to the designated
3-6 credentials verification organization authorized by the physician
3-7 to receive the data. Once the core credentials data are submitted
3-8 to the board, the physician is not required to resubmit this
3-9 initial data when applying for practice privileges with a health
3-10 care entity. However, each physician is responsible for providing
3-11 to the board within 30 days any corrections, updates, and
3-12 modifications to the core credentials data to ensure that all
3-13 credentialing data on the physician remains current. In addition,
3-14 physician's data on a form prescribed by the board.
3-15 (b) The board shall develop standard forms for:
3-16 (1) initial reporting of core credentials data;
3-17 (2) authorizing release of core credentials data; and
3-18 (3) subsequent reporting of corrections, updates, and
3-19 modifications.
3-20 (c) Any health care entity that employs, contracts with, or
3-21 credentials physicians must use the board to obtain core
3-22 credentials data for items the board is designated as a primary or
3-23 alternate source by a national accreditation organization. A
3-24 health care entity may act through its designated credentials
3-25 verification organization.
3-26 (d) Nothing in this section may be construed to restrict in
3-27 any way the authority of a health care entity to approve or deny an
4-1 application for or renewal of hospital staff membership, clinical
4-2 privileges, or managed care network participation.
4-3 Sec. 7.03. AVAILABILITY OF DATA COLLECTED. The board shall
4-4 make available to a health care entity or its designated
4-5 credentials verification organization all core credentials data it
4-6 collects on a physician, including corrections, updates, and
4-7 modifications to the data, if authorized by the physician. This
4-8 information shall be made available within 15 business days of the
4-9 receipt of the request.
4-10 Sec. 7.04. DUPLICATION OF DATA PROHIBITED. (a) A health
4-11 care entity is prohibited from collecting or attempting to collect
4-12 duplicate core credentials data from a physician if the information
4-13 is available from the board for items the board is designated as a
4-14 primary or alternate source by a national accreditation
4-15 organization. Nothing in this section may be construed to restrict
4-16 the right of a health care entity to request additional information
4-17 not included in the core credentials data file that is necessary in
4-18 order for the health care entity to credential the physician. Any
4-19 additional information required by the health care entity's
4-20 credentialing process may be collected from the primary sources of
4-21 that information either by the health care entity or by its
4-22 designated credentials verification organization.
4-23 (b) Effective September 1, 2002, a state agency may not
4-24 collect or attempt to collect duplicate core credentials data from
4-25 a physician if the information is already available from the board.
4-26 Nothing in this section may be construed to restrict the right of a
4-27 state agency to request additional information not included in the
5-1 core credentials data file but deemed necessary for the agency's
5-2 specific credentialing purposes.
5-3 (c) The board by rule may provide exceptions to the
5-4 provisions of Subsections (a) and (b) of this section if the
5-5 request for a type or class of information is necessary in order
5-6 for a health care entity to provide temporary privileges during the
5-7 credentialing process and such information is available from
5-8 another state agency. Such information may include licenser
5-9 verifications.
5-10 Sec. 7.05. LIABILITY. No civil, criminal, or administrative
5-11 action may be instituted, and there shall be no liability, against
5-12 any health care entity or its designated credentials verification
5-13 organization because of the health care entity's or verification
5-14 organization's reliance on any data obtained from the board under
5-15 this subchapter.
5-16 Sec. 7.06. REVIEW. Before releasing a physician's core
5-17 credentials data from its data bank for the first time, the board
5-18 shall provide the physician 15 business days to review the data and
5-19 request reconsideration or resolution of errors in, or omissions
5-20 of, data collected during the initial credentials verification
5-21 process. Any changes, comments, or clarifications made by the
5-22 physician shall be noted and included with the information in the
5-23 core credentials data. The board shall notify the physician of any
5-24 subsequent changes to the core credentials data when such changes
5-25 are made or initiated by a person other than the physician. A
5-26 physician may request to review the data collected at any time
5-27 after the initial release of information, but such request does not
6-1 require the board to hold, release, or modify any information.
6-2 Sec. 7.07. RULES. The board shall adopt rules necessary to
6-3 develop and implement the standardized credentials verification
6-4 program established by this subchapter.
6-5 Sec. 7.08. CONFIDENTIALITY. The information received,
6-6 collected, maintained, or stored by the board is proprietary
6-7 information and is privileged and confidential and cannot be
6-8 released, including by discovery or subpoena, except as provided by
6-9 this subchapter or otherwise authorized by law.
6-10 Sec. 7.09. USE OF INDEPENDENT CONTRACTOR. The board may
6-11 provide for the collecting, verifying, maintaining, storing, and
6-12 releasing of information through an independent contractor. Any
6-13 agreement between the board and such contractor shall provide for
6-14 board oversight and confidentiality and be awarded through a
6-15 competitive bid process.
6-16 Sec. 7.10. APPROPRIATIONS, GRANTS, AND DONATIONS. In
6-17 addition to any fees paid to the board or funds appropriated to the
6-18 board, the board may receive and accept gifts, grants, donations,
6-19 and any other type of funds or things of value from any source,
6-20 including the United States government and any private source.
6-21 Sec. 7.11. FEES. The board shall charge and collect fees
6-22 only in amounts necessary to cover the cost of operating and
6-23 administering the board's duties and functions under this
6-24 subchapter. The board may waive a fee for a state agency that is
6-25 required to use the core credentials data and that is prohibited
6-26 from collecting duplicate data by Section 7.04 of this Act.
6-27 SECTION 3. The Texas State Board of Medical Examiners is
7-1 required to implement the credentials verification program under
7-2 Subchapter G, Medical Practice Act (Article 4495b, Vernon's Texas
7-3 Civil States), as added by this Act, only if the legislature
7-4 appropriates money specifically for that purpose. If the
7-5 legislature does not appropriate money specifically for that
7-6 purpose, the board may, but is not required to, implement the
7-7 credentials verification program using other appropriations, gifts,
7-8 grants, or donations available for that purpose.
7-9 SECTION 4. The Texas State Board of Medical Examiners shall
7-10 make available the credentials reports required by Subchapter G,
7-11 Medical Practice Act (Article 4495b, Vernon's Texas Civil
7-12 Statutes), as added by this Act, starting not sooner than September
7-13 1, 2001. A health care entity is not required to use the board's
7-14 core credentials data until such data is available from the board
7-15 and the board is designated as a primary or alternate source by a
7-16 national accreditation organization.
7-17 SECTION 5. This Act takes effect September 1, 1999.
7-18 SECTION 6. The importance of this legislation and the
7-19 crowded condition of the calendars in both houses create an
7-20 emergency and an imperative public necessity that the
7-21 constitutional rule requiring bills to be read on three several
7-22 days in each house be suspended, and this rule is hereby suspended.