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 physician credentialing program helps to ensure access to
1-6 quality health care and also recognizes that physician
1-7 credentialing activities have increased significantly as a result
1-8 of health care reform and recent changes in health care delivery
1-9 and reimbursement systems. Moreover, the resulting duplication of
1-10 physician credentialing activities is unnecessarily costly and
1-11 cumbersome for both the practitioner and the entity granting
1-12 practice privileges. Therefore, it is the intent of the
1-13 legislature that a mandatory credentials collection program be
1-14 established which provides that once a physician's core credentials
1-15 data are collected, validated, maintained, and stored they need not
1-16 be collected again.
1-17 SECTION 2. The Medical Practice Act (Article 4495b, Vernon's
1-18 Texas Civil Statutes) is amended by adding Subchapter G to read as
1-19 follows:
1-20 SUBCHAPTER G. PHYSICIAN CREDENTIALING
1-21 Sec. 7.01. DEFINITIONS. In this subchapter:
1-22 (1) "Core credentials data" means:
1-23 (A) name and other demographic data;
1-24 (B) professional education;
2-1 (C) professional training;
2-2 (D) licenses; and
2-3 (E) Educational Commission for Foreign Medical
2-4 Graduates certification.
2-5 (2) "Credentials verification organization" means an
2-6 organization that is certified or accredited and organized to
2-7 collect, verify, maintain, store, and provide to health care
2-8 entities a health care practitioner's verified credentials data,
2-9 including all corrections, updates, and modifications to that data.
2-10 For purposes of this subdivision, "certified" or "accredited"
2-11 includes certification or accreditation by a nationally recognized
2-12 accreditation organization.
2-13 (3) "Health care entity" means:
2-14 (A) a health care facility or other health care
2-15 organization licensed or certified to provide approved medical and
2-16 allied health services in this state;
2-17 (B) an entity licensed by the Texas Department
2-18 of Insurance as a prepaid health care plan or health maintenance
2-19 organization or as an insurer to provide coverage for health care
2-20 services through a network of providers; or
2-21 (C) a health care provider entity accepting
2-22 delegated credentialing functions from a health maintenance
2-23 organization.
2-24 (4) "Physician" means a holder of or applicant for a
2-25 license under this Act as a medical doctor or doctor of osteopathy.
2-26 Sec. 7.01A. ASSOCIATIONS. Each provision of this Act that
2-27 applies to a health care entity also applies to an association that
3-1 represents federally qualified health centers. For purposes of
3-2 this section, "federally qualified health center" has the meaning
3-3 assigned by 42 U.S.C. Section 1396d(l)(2)(B), and its subsequent
3-4 amendments.
3-5 Sec. 7.02. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.
3-6 (a) The board shall develop standardized forms and guidelines for
3-7 and administer:
3-8 (1) the collection, verification, correction,
3-9 updating, modification, maintenance, and storage of information
3-10 relating to physician credentials; and
3-11 (2) the release of that information to health care
3-12 entities or designated credentials verification organizations
3-13 authorized by the physician to receive that information.
3-14 (b) Except as provided by Subsection (c), a physician whose
3-15 core credentials data is submitted to the board is not required to
3-16 resubmit the data when applying for practice privileges with a
3-17 health care entity.
3-18 (c) A physician shall:
3-19 (1) provide to the board any correction, update, or
3-20 modification of the physician's core credentials data not later
3-21 than the 30th day after the date the data on file is no longer
3-22 accurate; and
3-23 (2) resubmit the physician's core credentials data
3-24 annually if the physician did not submit a correction, update, or
3-25 modification during the preceding year.
3-26 (d) A health care entity that employs, contracts with, or
3-27 credentials physicians must use the board to obtain core
4-1 credentials data for items for which the board is designated or
4-2 accepted as a primary source by a national accreditation
4-3 organization. A health care entity may act through its designated
4-4 credentials verification organization.
4-5 (e) This section does not restrict the authority of a health
4-6 care entity to approve or deny an original or renewal application
4-7 for hospital staff membership, clinical privileges, or managed care
4-8 network participation.
4-9 Sec. 7.03. FURNISHING OF DATA TO HEALTH CARE ENTITY. Not
4-10 later than the 15th business day after the date the board receives
4-11 a request for the data, the board shall make available to a health
4-12 care entity or its designated credentials verification organization
4-13 all core credentials data it collects on a physician, including any
4-14 correction, update, or modification of that data, if authorized by
4-15 the physician.
4-16 Sec. 7.04. REVIEW OF DATA BY PHYSICIAN. (a) Before
4-17 releasing a physician's core credentials data from its data bank
4-18 for the first time, the board shall provide to the affected
4-19 physician 15 business days to review the data and request
4-20 reconsideration or resolution of errors in or omissions from the
4-21 data. The board shall include with the data any change or
4-22 clarification made by the physician.
4-23 (b) The board shall notify a physician of any change to the
4-24 physician's core credentials data when a change is made or
4-25 initiated by a person other than the physician.
4-26 (c) A physician may request to review the physician's core
4-27 credentials data collected at any time after the initial release of
5-1 information, but the board is not required by virtue of a request
5-2 to hold, release, or modify any information.
5-3 Sec. 7.05. DATA DUPLICATION PROHIBITED. (a) A health care
5-4 entity may not collect or attempt to collect duplicate core
5-5 credentials data from a physician if the information is already on
5-6 file with the board. This section does not restrict the right of a
5-7 health care entity to request additional information not included
5-8 in the core credentials data on file with the board that is
5-9 necessary for the entity to credential the physician. A health
5-10 care entity or its designated credentials verification organization
5-11 may collect any additional information required by the health care
5-12 entity's credentialing process from a primary source of that
5-13 information.
5-14 (b) A state agency may not collect or attempt to collect
5-15 duplicate core credentials data from a physician if the information
5-16 is already on file with the board. This section does not restrict
5-17 the right of a state agency to request additional information not
5-18 included in the core credentials data on file with the board that
5-19 the agency considers necessary for its specific credentialing
5-20 purposes.
5-21 (c) The board by rule may except from Subsections (a) and
5-22 (b) of this section a request for core credentials data that is
5-23 necessary for a health care entity to provide temporary privileges
5-24 during the credentialing process.
5-25 Sec. 7.06. IMMUNITY. A health care entity or its designated
5-26 credentials verification organization is immune from liability
5-27 arising from its reliance on data furnished by the board under this
6-1 subchapter.
6-2 Sec. 7.07. RULES. The board shall adopt rules as necessary
6-3 to develop and implement the standardized credentials verification
6-4 program established by this subchapter.
6-5 Sec. 7.08. CONFIDENTIALITY. The information collected,
6-6 maintained, or stored by the board under this subchapter is
6-7 privileged and confidential and not subject to discovery, subpoena,
6-8 or other means of legal compulsion for its release or to disclosure
6-9 under Chapter 552, Government Code, except as otherwise provided by
6-10 this subchapter.
6-11 Sec. 7.09. USE OF INDEPENDENT CONTRACTOR. The board may
6-12 contract with an independent contractor to collect, verify,
6-13 maintain, store, or release information. The contract must provide
6-14 for board oversight and for the confidentiality of the information.
6-15 If the board contracts with an independent entity that is not a
6-16 governmental unit to carry out the provisions of this subchapter,
6-17 the independent entity is not immune from liability.
6-18 Sec. 7.10. FEES. (a) The board shall charge and collect
6-19 fees in amounts necessary to cover its cost of operating and
6-20 administering its duties and functions under this subchapter.
6-21 (b) The board may waive a fee for a state agency that is
6-22 required to obtain core credentials data from the board and that is
6-23 prohibited by Section 7.05 of this Act from collecting duplicate
6-24 data.
6-25 Sec. 7.11. GIFTS, GRANTS, AND DONATIONS. In addition to any
6-26 fees paid to the board or money appropriated to the board, the
6-27 board may receive and accept a gift, grant, donation, or other
7-1 thing of value from any source, including the United States or a
7-2 private source.
7-3 SECTION 3. The Texas State Board of Medical Examiners shall
7-4 implement this Act only if the legislature appropriates money
7-5 specifically for that purpose. If the legislature does not
7-6 appropriate money specifically for that purpose, the board may
7-7 implement this Act using other appropriations, gifts, grants, or
7-8 donations available for that purpose.
7-9 SECTION 4. (a) Except as provided by Section 3 of this Act,
7-10 not later than September 1, 2001, the Texas State Board of Medical
7-11 Examiners shall make available the core credentials data required
7-12 by this Act.
7-13 (b) A health care entity is not required to use the board's
7-14 core credentials data until September 1, 2001, and not until that
7-15 data is available from the board for items for which the board is
7-16 designated or accepted as a primary source by a national
7-17 accreditation organization.
7-18 SECTION 5. This Act takes effect September 1, 1999.
7-19 SECTION 6. The importance of this legislation and the
7-20 crowded condition of the calendars in both houses create an
7-21 emergency and an imperative public necessity that the
7-22 constitutional rule requiring bills to be read on three several
7-23 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 3216 was passed by the House on May
4, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 3216 on May 27, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 3216 was passed by the Senate, with
amendments, on May 25, 1999, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor