By McCall H.B. No. 3216
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
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 Medical Practice Act, Article 4495b, is
1-5 amended to add a new subchapter G to read as follows:
1-6 Section 7.01. FINDINGS AND PURPOSES. The Legislature
1-7 recognizes that an efficient and effective physician credentialing
1-8 program helps to ensure access to quality health care and also
1-9 recognizes that physician credentialing activities have increased
1-10 significantly as a result of health care reform and recent changes
1-11 in health care delivery and reimbursement systems. Moreover, the
1-12 resulting duplication of physician credentialing activities is
1-13 unnecessarily costly and cumbersome for both the practitioner and
1-14 the entity granting practice privileges. Therefore, it is the
1-15 intent of the Legislature that a mandatory credentials collection
1-16 program be established which provides that, once a physician's core
1-17 credentials data are collected, validated, maintained, and stored,
1-18 they need not be collected again.
1-19 Section 7.02. CREDENTIALS VERIFICATION COUNCIL. (a) The
1-20 Credentials Verification Council is created to develop standardized
1-21 forms and guidelines and to administer the collecting, verifying,
2-1 maintaining and storing of information relating to physician
2-2 credentials and for releasing that information to health care
2-3 entities authorized by the physician to receive such information.
2-4 (b) The Credentials Verification Council shall consist of 10
2-5 members. The Executive Director of the Board, or his or her
2-6 designee, shall serve as one member and chair of the council and
2-7 shall appoint the remaining 10 members. Except for any initial
2-8 lesser term required to achieve staggering, such appointments shall
2-9 be for 4-year staggered terms, with one 4-year reappointment, as
2-10 applicable. One member shall represent hospitals, and one member
2-11 shall represent health maintenance organizations. One member shall
2-12 represent health insurance entities. Six members shall be members
2-13 of the board and selected to provide that three members will be
2-14 doctors of medicine (MD), one member will be a doctor of
2-15 osteopathic medicine (DO), and two will be public members.
2-16 Section 7.03. ADMINISTRATION. The Council established
2-17 herein is administratively attached to the Texas State Board of
2-18 Medical Examiners who shall provide administrative and operational
2-19 duties and functions for the Council Employees of the Texas State
2-20 Board of Medical Examiners shall serve as staff for the Council.
2-21 Section 7.04. DEFINITIONS. As used in this subchapter, the
2-22 term:
2-23 (a) Council" means the Credentials Verification Council.
2-24 (b) "Core credentials data" means the following data:
2-25 current and former name(s) and any alias, any professional
3-1 education, professional training, licensure, specialty board
3-2 certification, Educational Commission for Foreign Medical Graduates
3-3 certification, hospital affiliations and staff status and dates of
3-4 affiliation for each, other institutional affiliations and dates of
3-5 affiliation for each evidence of professional liability coverage or
3-6 evidence of financial responsibility, Medicare or Medicaid
3-7 sanctions and other data defined by the board. Any core
3-8 credentials data which is verified by the council must be verified
3-9 according to board standards.
3-10 (c) "Credentialing" means the process of assessing and
3-11 verifying the qualifications of a licensed physician.
3-12 (d) "Credentialing Verification Organization," means any
3-13 organization certified or accredited as a credentials verification
3-14 organization for the express purpose of collecting, verifying,
3-15 maintaining, storing, and providing to health care entities a
3-16 health care practitioner's verified core credentials data,
3-17 including all corrections, updates, and modifications thereto, as
3-18 authorized by the health care practitioners. For the purposes of
3-19 this subsection "certified" or "accredited," as applicable, means
3-20 approved by a quality assessment program, from the National
3-21 Committee for Quality Assurance, the Joint Commission on
3-22 Accreditation of Health Care Organizations, the American
3-23 Accreditation Health Care Commission/URAC, or any other such
3-24 nationally recognized and accepted organization authorized or
3-25 approved by the Council, used to assess and certify any credentials
4-1 verification program, entity, or organization that verifies the
4-2 credentials of any health care practitioner.
4-3 (e) "Board" means the Texas State Board of Medical
4-4 Examiners.
4-5 (f) "Drug Enforcement Administration certification" means
4-6 evidence of current certification with the current address to which
4-7 the certificate is issued.
4-8 (g) "Health care entity" means:
4-9 (1) Any health care facility or other health care
4-10 organization licensed or certified to provide approved medical and
4-11 allied health services in Texas;
4-12 (2) Any entity licensed by the Department of Insurance as a
4-13 prepaid health care plan or health maintenance organization or as
4-14 an insurer to provide coverage for health care services through a
4-15 network of providers.
4-16 (3) Any health care provider entity accepting delegated
4-17 credentialing function from a health maintenance organization.
4-18 (h) "Physician" means any person licensed or applying for
4-19 licensure under Art. 4495b, Vernon's Texas Revised Civil Statutes
4-20 based on the MD or DO degree.
4-21 (i) "Hospital affiliations" means the name and address of
4-22 the institution(s), staff status and dates of affiliation for each.
4-23 (j) "Licensure core credentials data" means the data
4-24 required for initial licensure applicants under the medical
4-25 practice act.
5-1 (k) "National accrediting organization" means an
5-2 organization that awards accreditation or certification to
5-3 hospitals, managed care organizations, credentials verification
5-4 organizations, or other health care organizations, including, to,
5-5 the Joint Commission on Accreditation of the HealthCare
5-6 Organizations, the American Accreditation of HealthCare
5-7 Commission/URAC, and the National Committee for Quality Assurance.
5-8 (1) "Primary source verification" means verification of
5-9 professional qualifications based on evidence obtained directly
5-10 from the issuing source of the applicable qualification.
5-11 (m) "Professional training" means any internship, residency,
5-12 or fellowship.
5-13 (n) "Recredentialing" means the periodic updating and
5-14 re-verification of core credentials data.
5-15 (o) "Secondary source verification" means confirmation of a
5-16 professional qualification by means other than primary source
5-17 verification, as outlined and approved by the board.
5-18 (p) "Specialty board certification" means evidence of
5-19 current and active certificate of specialization from a specialty
5-20 board recognized by the board.
5-21 Section 7.05. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.
5-22 (a) In accordance with the provisions of this section, the council
5-23 shall develop standardized forms and guidelines for collecting,
5-24 verifying, maintaining, and storing core credentials data and for
5-25 releasing it to health entities or its designated credentials
6-1 verification organization authorized by the physician to receive
6-2 the data. Once the core credentials data are submitted to the
6-3 council, the physician is not required to resubmit this initial
6-4 data when applying for practice privileges with a health care
6-5 entity. However, each physician, is responsible for providing to
6-6 the council within 60 days, any corrections, updates, and
6-7 modifications to his or her core credentials data, to ensure that
6-8 all credentialing data on the physician remains current. In
6-9 addition, if no data has been reported, a physician must update
6-10 annually his or her data on a form prescribed by the council.
6-11 (b) The council, in consultation with the board, shall
6-12 develop standard forms for (1) the initial reporting of core
6-13 credentials data for credentialing purposes, (2) the physician to
6-14 authorize release of core credentials data, and (3) the subsequent
6-15 reporting of corrections, updates, and modifications for
6-16 recredentialing purposes.
6-17 (c) Any health care entity that employs, contracts with, or
6-18 allows physicians to treat its patients must use the credentials
6-19 verification council to obtain core credentials data on a physician
6-20 applying for privileges with that entity. A health care entity may
6-21 act through its designated credentials verification organization.
6-22 (d) Nothing in this section may be construed to restrict
6-23 access to the National Practitioner Data Bank by the board, the
6-24 council or any health care entity.
6-25 (e) Nothing in this section may be construed to restrict in
7-1 any way the authority of the health care entity to approve or deny
7-2 an application for hospital staff membership, clinical privileges,
7-3 or managed care network participation.
7-4 Section 7.06. AVAILABILITY OF DATA COLLECTED. (a) The
7-5 council shall make available to a health care entity or its
7-6 designated credentials verification organization, all core
7-7 credentials data it collects on any physician, including
7-8 corrections, updates, and modifications thereto, if authorized by
7-9 the physician. The council shall charge the health care entity or
7-10 its designated credentials verification organization a reasonable
7-11 fee to access all core credentialing data it maintains on
7-12 physicians. This fee shall be set in consultation with the
7-13 council.
7-14 Section 7.07. DUPLICATION OF DATA PROHIBITED. (a) A health
7-15 care entity is prohibited from collecting or attempting to collect
7-16 duplicate core credentials data from any physician if the
7-17 information is available from the council. Nothing in this section
7-18 may be construed to restrict the right of any health care entity to
7-19 request additional information not included in the core credentials
7-20 data file, which is necessary for it to credential the physician.
7-21 Any additional information required by the health care entity's
7-22 credentialing process may be collected from the primary sources of
7-23 that information either by the health care entity or its designated
7-24 credentials verification organization. The Council by rule may add
7-25 data elements to the core credential data set.
8-1 (b) Effective July 1, 2002, a Texas state agency, may not
8-2 collect or attempt to collect duplicate core credentials data from
8-3 any individual physician if the information is already available
8-4 from the council. Nothing in this section may be construed to
8-5 restrict the right of any state agency to request additional
8-6 information not included in the core credential data file, but
8-7 which is deemed necessary for the agency's specific credentialing
8-8 purposes.
8-9 Section 7.08. LIABILITY. No civil, criminal, or
8-10 administrative action may be instituted, and there shall be no
8-11 liability, against any health care entity on account of its
8-12 reliance on any data obtained from the council.
8-13 Section 7.09. REVIEW. Before releasing a physician's core
8-14 credentials data from its data bank, the council must provide the
8-15 practitioner up to 30 days to review such data and request
8-16 reconsideration or resolution of errors in, or omissions of, date
8-17 collected during the credentials verification process.
8-18 Section 7.10. VERIFICATION OF CREDENTIALS DATA. The primary
8-19 and secondary source verification procedures used by the council
8-20 must meet the national standards as outlined by national
8-21 accrediting organizations and the Council must be appropriately
8-22 accredited by such national accrediting organizations.
8-23 Section 7.11. RULES. The board, in consultation with the
8-24 council, shall adopt rules necessary to develop and implement the
8-25 standardized credentials verification program established by this
9-1 subsection.
9-2 Section 7.12. CONFIDENTIALITY. The information received,
9-3 collected or stored by the Council is proprietary information and
9-4 is privileged and confidential and cannot be released except as
9-5 provided by this subchapter. The information received collected or
9-6 stored by the Council is not subject to the Open Records Law, Gov't
9-7 Code, Chapter 552.
9-8 Section 7.13. APPROPRIATIONS, GRANTS AND DONATIONS. In
9-9 addition to any fees paid to the Council or funds appropriated to
9-10 the Council, the Council may receive and accept gifts, grants,
9-11 donations, and any other type of funds or things of value from any
9-12 source, including the United States Government and any private
9-13 source.
9-14 Section 7.14. FEES. The Council in consultation with the
9-15 board, shall charge and collect fees in amounts necessary to cover
9-16 its cost of operating and administering its duties and functions
9-17 under this subchapter. The Council shall pay and otherwise
9-18 compensate the board for any and all of its expenses and services
9-19 rendered on behalf of the Council.
9-20 SECTION 2. The Council shall study the feasibility of adding
9-21 additional health care providers to credentials verification
9-22 services that it provides. The study shall include a cost estimate
9-23 and phase in requirements that may be necessary. The Council shall
9-24 report to the Speaker of the House and to the Lt. Governor no
9-25 later than December 1, 2000.
10-1 SECTION 3. The council shall appoint a task force no later
10-2 than January 5, 2000 to develop procedures to expand the
10-3 standardized credentials verification program to include office
10-4 site visits and medical chart reviews. The Task Force will report
10-5 back to the council no later than December 1, 2000, and the Council
10-6 shall report to the Speaker of the House and to the Lt. Governor
10-7 by December 31, 2000.
10-8 SECTION 4. This Act takes effect September 1, 1999.
10-9 SECTION 5. The Council shall make available the credentials
10-10 reports required by this act starting not later than July 1, 2000.
10-11 SECTION 6. The importance of the legislation and the crowded
10-12 condition of the calendars in both houses create an emergency and
10-13 an imperative public necessity that the constitutional rule
10-14 requiring bills to be read on three several days in each house be
10-15 suspended, and this rule is hereby suspended.