1-1 By: McCall (Senate Sponsor - Cain) H.B. No. 3216 1-2 (In the Senate - Received from the House May 6, 1999; 1-3 May 7, 1999, read first time and referred to Committee on Health 1-4 Services; May 13, 1999, reported adversely, with favorable 1-5 Committee Substitute by the following vote: Yeas 5, Nays 0; 1-6 May 13, 1999, sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR H.B. No. 3216 By: Moncrief 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to the standardization of credentialing of physicians. 1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-12 SECTION 1. The legislature recognizes that an efficient and 1-13 effective physician credentialing program helps to ensure access to 1-14 quality health care and also recognizes that physician 1-15 credentialing activities have increased significantly as a result 1-16 of health care reform and recent changes in health care delivery 1-17 and reimbursement systems. Moreover, the resulting duplication of 1-18 physician credentialing activities is unnecessarily costly and 1-19 cumbersome for both the practitioner and the entity granting 1-20 practice privileges. Therefore, it is the intent of the 1-21 legislature that a mandatory credentials collection program be 1-22 established which provides that once a physician's core credentials 1-23 data are collected, validated, maintained, and stored they need not 1-24 be collected again. 1-25 SECTION 2. The Medical Practice Act (Article 4495b, Vernon's 1-26 Texas Civil Statutes) is amended by adding Subchapter G to read as 1-27 follows: 1-28 SUBCHAPTER G. PHYSICIAN CREDENTIALING 1-29 Sec. 7.01. DEFINITIONS. In this subchapter: 1-30 (1) "Core credentials data" means: 1-31 (A) name and other demographic data; 1-32 (B) professional education; 1-33 (C) professional training; 1-34 (D) licenses; and 1-35 (E) Educational Commission for Foreign Medical 1-36 Graduates certification. 1-37 (2) "Credentials verification organization" means an 1-38 organization that is certified or accredited and organized to 1-39 collect, verify, maintain, store, and provide to health care 1-40 entities a health care practitioner's verified credentials data, 1-41 including all corrections, updates, and modifications to that data. 1-42 For purposes of this subdivision, "certified" or "accredited" 1-43 includes certification or accreditation by a nationally recognized 1-44 accreditation organization. 1-45 (3) "Health care entity" means: 1-46 (A) a health care facility or other health care 1-47 organization licensed or certified to provide approved medical and 1-48 allied health services in this state; 1-49 (B) an entity licensed by the Texas Department 1-50 of Insurance as a prepaid health care plan or health maintenance 1-51 organization or as an insurer to provide coverage for health care 1-52 services through a network of providers; or 1-53 (C) a health care provider entity accepting 1-54 delegated credentialing functions from a health maintenance 1-55 organization. 1-56 (4) "Physician" means a holder of or applicant for a 1-57 license under this Act as a medical doctor or doctor of osteopathy. 1-58 Sec. 7.01A. ASSOCIATIONS. Each provision of this Act that 1-59 applies to a health care entity also applies to an association that 1-60 represents federally qualified health centers. For purposes of 1-61 this section, "federally qualified health center" has the meaning 1-62 assigned by 42 U.S.C. Section 1396d(l)(2)(B), and its subsequent 1-63 amendments. 1-64 Sec. 7.02. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM. 2-1 (a) The board shall develop standardized forms and guidelines for 2-2 and administer: 2-3 (1) the collection, verification, correction, 2-4 updating, modification, maintenance, and storage of information 2-5 relating to physician credentials; and 2-6 (2) the release of that information to health care 2-7 entities or designated credentials verification organizations 2-8 authorized by the physician to receive that information. 2-9 (b) Except as provided by Subsection (c), a physician whose 2-10 core credentials data is submitted to the board is not required to 2-11 resubmit the data when applying for practice privileges with a 2-12 health care entity. 2-13 (c) A physician shall: 2-14 (1) provide to the board any correction, update, or 2-15 modification of the physician's core credentials data not later 2-16 than the 30th day after the date the data on file is no longer 2-17 accurate; and 2-18 (2) resubmit the physician's core credentials data 2-19 annually if the physician did not submit a correction, update, or 2-20 modification during the preceding year. 2-21 (d) A health care entity that employs, contracts with, or 2-22 credentials physicians must use the board to obtain core 2-23 credentials data for items for which the board is designated or 2-24 accepted as a primary source by a national accreditation 2-25 organization. A health care entity may act through its designated 2-26 credentials verification organization. 2-27 (e) This section does not restrict the authority of a health 2-28 care entity to approve or deny an original or renewal application 2-29 for hospital staff membership, clinical privileges, or managed care 2-30 network participation. 2-31 Sec. 7.03. FURNISHING OF DATA TO HEALTH CARE ENTITY. Not 2-32 later than the 15th business day after the date the board receives 2-33 a request for the data, the board shall make available to a health 2-34 care entity or its designated credentials verification organization 2-35 all core credentials data it collects on a physician, including any 2-36 correction, update, or modification of that data, if authorized by 2-37 the physician. 2-38 Sec. 7.04. REVIEW OF DATA BY PHYSICIAN. (a) Before 2-39 releasing a physician's core credentials data from its data bank 2-40 for the first time, the board shall provide to the affected 2-41 physician 15 business days to review the data and request 2-42 reconsideration or resolution of errors in or omissions from the 2-43 data. The board shall include with the data any change or 2-44 clarification made by the physician. 2-45 (b) The board shall notify a physician of any change to the 2-46 physician's core credentials data when a change is made or 2-47 initiated by a person other than the physician. 2-48 (c) A physician may request to review the physician's core 2-49 credentials data collected at any time after the initial release of 2-50 information, but the board is not required by virtue of a request 2-51 to hold, release, or modify any information. 2-52 Sec. 7.05. DATA DUPLICATION PROHIBITED. (a) A health care 2-53 entity may not collect or attempt to collect duplicate core 2-54 credentials data from a physician if the information is already on 2-55 file with the board. This section does not restrict the right of a 2-56 health care entity to request additional information not included 2-57 in the core credentials data on file with the board that is 2-58 necessary for the entity to credential the physician. A health 2-59 care entity or its designated credentials verification organization 2-60 may collect any additional information required by the health care 2-61 entity's credentialing process from a primary source of that 2-62 information. 2-63 (b) A state agency may not collect or attempt to collect 2-64 duplicate core credentials data from a physician if the information 2-65 is already on file with the board. This section does not restrict 2-66 the right of a state agency to request additional information not 2-67 included in the core credentials data on file with the board that 2-68 the agency considers necessary for its specific credentialing 2-69 purposes. 3-1 (c) The board by rule may except from Subsections (a) and 3-2 (b) of this section a request for core credentials data that is 3-3 necessary for a health care entity to provide temporary privileges 3-4 during the credentialing process. 3-5 Sec. 7.06. IMMUNITY. A health care entity or its designated 3-6 credentials verification organization is immune from liability 3-7 arising from its reliance on data furnished by the board under this 3-8 subchapter. 3-9 Sec. 7.07. RULES. The board shall adopt rules as necessary 3-10 to develop and implement the standardized credentials verification 3-11 program established by this subchapter. 3-12 Sec. 7.08. CONFIDENTIALITY. The information collected, 3-13 maintained, or stored by the board under this subchapter is 3-14 privileged and confidential and not subject to discovery, subpoena, 3-15 or other means of legal compulsion for its release or to disclosure 3-16 under Chapter 552, Government Code, except as otherwise provided by 3-17 this subchapter. 3-18 Sec. 7.09. USE OF INDEPENDENT CONTRACTOR. The board may 3-19 contract with an independent contractor to collect, verify, 3-20 maintain, store, or release information. The contract must provide 3-21 for board oversight and for the confidentiality of the information. 3-22 Sec. 7.10. FEES. (a) The board shall charge and collect 3-23 fees in amounts necessary to cover its cost of operating and 3-24 administering its duties and functions under this subchapter. 3-25 (b) The board may waive a fee for a state agency that is 3-26 required to obtain core credentials data from the board and that is 3-27 prohibited by Section 7.05 of this Act from collecting duplicate 3-28 data. 3-29 Sec. 7.11. GIFTS, GRANTS, AND DONATIONS. In addition to any 3-30 fees paid to the board or money appropriated to the board, the 3-31 board may receive and accept a gift, grant, donation, or other 3-32 thing of value from any source, including the United States or a 3-33 private source. 3-34 SECTION 3. The Texas State Board of Medical Examiners shall 3-35 implement this Act only if the legislature appropriates money 3-36 specifically for that purpose. If the legislature does not 3-37 appropriate money specifically for that purpose, the board may 3-38 implement this Act using other appropriations, gifts, grants, or 3-39 donations available for that purpose. 3-40 SECTION 4. (a) Except as provided by Section 3 of this Act, 3-41 not later than September 1, 2001, the Texas State Board of Medical 3-42 Examiners shall make available the core credentials data required 3-43 by this Act. 3-44 (b) A health care entity is not required to use the board's 3-45 core credentials data until September 1, 2001, and not until that 3-46 data is available from the board for items for which the board is 3-47 designated or accepted as a primary source by a national 3-48 accreditation organization. 3-49 SECTION 5. This Act takes effect September 1, 1999. 3-50 SECTION 6. The importance of this legislation and the 3-51 crowded condition of the calendars in both houses create an 3-52 emergency and an imperative public necessity that the 3-53 constitutional rule requiring bills to be read on three several 3-54 days in each house be suspended, and this rule is hereby suspended. 3-55 * * * * *