By McCall H.B. No. 3216 Substitute the following for H.B. No. 3216: By Capelo C.S.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; 2-3 (E) Educational Commission for Foreign Medical 2-4 Graduates certification and 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 "certified" 2-12 or "accredited," shall include nationally recognized accreditation 2-13 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 3-3 board shall develop standardized forms and guidelines for 3-4 collecting, verifying, maintaining, and storing core credentials 3-5 data and for releasing the data to health care entities or to the 3-6 designated credentials verification organization authorized by the 3-7 physician to receive the data. Once the core credentials data are 3-8 submitted to the board, the physician is not required to resubmit 3-9 this initial data when applying for practice privileges with a 3-10 health care entity. However, each physician is responsible for 3-11 providing 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 Statutes) 7-12 as added by this Act starting not sooner than September 1, 2001. A 7-13 health care entity is not required to use the board's core 7-14 credentials data until such data is available from the board and 7-15 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.