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.
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