By: Cain S.B. No. 1618
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the standardization of credentialing of physicians.
1-2 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-3 SECTION 1. The Medical Practice Act, Article 4495b, is
1-4 amended to add a new subchapter G to read as follows:
1-5 Section 7.01. Findings and Purposes. The Legislature
1-6 recognizes that an efficient and effective physician credentialing
1-7 program helps to ensure access to quality health care and also
1-8 recognizes that physician credentialing activities have increased
1-9 significantly as a result of health care reform and recent changes
1-10 in health care delivery and reimbursement systems. Moreover, the
1-11 resulting duplication of physician credentialing activities is
1-12 unnecessarily costly and cumbersome for both the practitioner and
1-13 the entity granting practice privileges. Therefore, it is the
1-14 intent of the Legislature that a mandatory credentials collection
1-15 program be established which provides that, once a physician's core
1-16 credentials data are collected, validated, maintained, and stored,
1-17 they need not be collected again.
1-18 Section 7.02. Credentials Verification Council.
1-19 (a) The Credentials Verification Council is created to
1-20 develop standardized forms and guidelines and to administer the
1-21 collecting, verifying, maintaining and storing of information
1-22 relating to physician credentials and for releasing that
2-1 information to health care entities authorized by the physician to
2-2 receive such information.
2-3 (b) The Credentials Verification Council shall consist of 10
2-4 members. The Executive Director of the Board, or his or her
2-5 designee, shall serve as one member and chair of the council and
2-6 shall appoint the remaining 10 members. Except for any initial
2-7 lesser term required to achieve staggering, such appointments shall
2-8 be for 4-year staggered terms, with one 4-year reappointment, as
2-9 applicable. One member shall represent hospitals, and one member
2-10 shall represent health maintenance organizations. One member shall
2-11 represent health insurance entities. Six members shall be members
2-12 of the board and selected to provide that three members will be
2-13 doctors of medicine (MD), one member will be a doctor of
2-14 osteopathic medicine (DO), and two will be public members.
2-15 Section 7.03. Administration. The Council established
2-16 herein is administratively attached to the Texas State Board of
2-17 Medical Examiners who shall provide administrative and operational
2-18 duties and functions for the Council Employees of the Texas State
2-19 Board of Medical Examiners shall serve as staff for the Council.
2-20 Section 7.04. Definitions. As used in this subchapter, the
2-21 term:
2-22 (a) Council" means the Credentials Verification Council.
2-23 (b) "Core credentials data" means the following data:
2-24 current and former name(s) and any alias, any professional
2-25 education, professional training, licensure, specialty board
2-26 certification, Educational Commission for Foreign Medical Graduates
3-1 certification, hospital affiliations and staff status and dates of
3-2 affiliation for each, other institutional affiliations and dates of
3-3 affiliation for each evidence of professional liability coverage or
3-4 evidence of financial responsibility, Medicare or Medicaid
3-5 sanctions and other data defined by the board. Any core
3-6 credentials data which is verified by the council must be verified
3-7 according to board standards.
3-8 (c) "Credentialing" means the process of assessing and
3-9 verifying the qualifications of a licensed physician.
3-10 (d) "Credentialing Verification Organization," means any
3-11 organization certified or accredited as a credentials verification
3-12 organization for the express purpose of collecting, verifying,
3-13 maintaining, storing, and providing to health care entities a
3-14 health care practitioner's verified core credentials data,
3-15 including all corrections, updates, and modifications thereto, as
3-16 authorized by the health care practitioners. For the purposes of
3-17 this subsection "certified" or "accredited," as applicable, means
3-18 approved by a quality assessment program, from the National
3-19 Committee for Quality Assurance, the Joint Commission on
3-20 Accreditation of Health Care Organizations, the American
3-21 Accreditation Health Care Commission/URAC, or any other such
3-22 nationally recognized and accepted organization authorized or
3-23 approved by the Council, used to assess and certify any credentials
3-24 verification program, entity, or organization that verifies the
3-25 credentials of any health care practitioner.
3-26 (e) "Board" means the Texas State Board of Medical
4-1 Examiners.
4-2 (f) "Drug Enforcement Administration certification" means
4-3 evidence of current certification with the current address to which
4-4 the certificate is issued.
4-5 (g) "Health care entity" means:
4-6 1. Any health care facility or other health care
4-7 organization licensed or certified to provide approved medical and
4-8 allied health services in Texas;
4-9 2. Any entity licensed by the Department of Insurance as a
4-10 prepaid health care plan or health maintenance organization or as
4-11 an insurer to provide coverage for health care services through a
4-12 network of providers.
4-13 3. Any health care provider entity accepting delegated
4-14 credentialing function from a health maintenance organization.
4-15 (h) "Physician" means any person licensed or applying for
4-16 licensure under Art. 4495b, Vernon's Texas Revised Civil Statutes
4-17 based on the MD or DO degree.
4-18 (i) "Hospital affiliations" means the name and address of
4-19 the institution(s), staff status and dates of affiliation for each.
4-20 (j) "Licensure core credentials data" means the data
4-21 required for initial licensure applicants under the medical
4-22 practice act.
4-23 (k) "National accrediting organization" means an
4-24 organization that awards accreditation or certification to
4-25 hospitals, managed care organizations, credentials verification
4-26 organizations, or other health care organizations, including, to,
5-1 the Joint Commission on Accreditation of the HealthCare
5-2 Organizations, the American Accreditation of HealthCare
5-3 Commission/URAC, and the National Committee for Quality Assurance.
5-4 (1) "Primary source verification" means verification of
5-5 professional qualifications based on evidence obtained directly
5-6 from the issuing source of the applicable qualification.
5-7 (m) "Professional training" means any internship, residency,
5-8 or fellowship.
5-9 (n) "Recredentialing" means the periodic updating and
5-10 re-verification of core credentials data.
5-11 (o) "Secondary source verification" means confirmation of a
5-12 professional qualification by means other than primary source
5-13 verification, as outlined and approved by the board.
5-14 (p) "Specialty board certification" means evidence of
5-15 current and active certificate of specialization from a specialty
5-16 board recognized by the board.
5-17 Section 7.05. Standardized Credentials Verification Program.
5-18 (a) In accordance with the provisions of this section, the
5-19 council shall develop standardized forms and guidelines for
5-20 collecting, verifying, maintaining, and storing core credentials
5-21 data and for releasing it to health entities or its designated
5-22 credentials verification organization authorized by the physician
5-23 to receive the data. Once the core credentials data are submitted
5-24 to the council, the physician is not required to resubmit this
5-25 initial data when applying for practice privileges with a health
5-26 care entity. However, each physician, is responsible for providing
6-1 to the council within 60 days, any corrections, updates, and
6-2 modifications to his or her core credentials data, to ensure that
6-3 all credentialing data on the physician remains current. In
6-4 addition, if no data has been reported, a physician must update
6-5 annually his or her data on a form prescribed by the council.
6-6 (b) The council, in consultation with the board, shall
6-7 develop standard forms for (1) the initial reporting of core
6-8 credentials data for credentialing purposes, (2) the physician to
6-9 authorize release of core credentials data, and (3) the subsequent
6-10 reporting of corrections, updates, and modifications for
6-11 recredentialing purposes.
6-12 (c) Any health care entity that employs, contracts with, or
6-13 allows physicians to treat its patients must use the credentials
6-14 verification council to obtain core credentials data on a physician
6-15 applying for privileges with that entity. A health care entity may
6-16 act through its designated credentials verification organization.
6-17 (d) Nothing in this section may be construed to restrict
6-18 access to the National Practitioner Data Bank by the board, the
6-19 council or any health care entity.
6-20 (e) Nothing in this section may be construed to restrict in
6-21 any way the authority of the health care entity to approve or deny
6-22 an application for hospital staff membership, clinical privileges,
6-23 or managed care network participation.
6-24 Section 7.06. Availability of Data Collected.
6-25 (a) The council shall make available to a health care entity
6-26 or its designated credentials verification organization, all core
7-1 credentials data it collects on any physician, including
7-2 corrections, updates, and modifications thereto, if authorized by
7-3 the physician. The council shall charge the health care entity or
7-4 its designated credentials verification organization a reasonable
7-5 fee to access all core credentialing data it maintains on
7-6 physicians. This fee shall be set in consultation with the
7-7 council.
7-8 Section 7.07. Duplication of Data Prohibited.
7-9 (a) A health care entity is prohibited from collecting or
7-10 attempting to collect duplicate core credentials data from any
7-11 physician if the information is available from the council.
7-12 Nothing in this section may be construed to restrict the right of
7-13 any health care entity to request additional information not
7-14 included in the core credentials data file, which is necessary for
7-15 it to credential the physician. Any additional information
7-16 required by the health care entity's credentialing process may be
7-17 collected from the primary sources of that information either by
7-18 the health care entity or its designated credentials verification
7-19 organization. The Council by rule may add data elements to the
7-20 core credential data set.
7-21 (b) Effective July 1, 2002, a Texas state agency, may not
7-22 collect or attempt to collect duplicate core credentials data from
7-23 any individual physician if the information is already available
7-24 from the council. Nothing in this section may be construed to
7-25 restrict the right of any state agency to request additional
7-26 information not included in the core credential data file, but
8-1 which is deemed necessary for the agency's specific credentialing
8-2 purposes.
8-3 Section 7.08. Liability.
8-4 No civil, criminal, or administrative action may be instituted, and
8-5 there shall be no liability, against any health care entity on
8-6 account of its reliance on any data obtained from the council.
8-7 Section 7.09. Review.
8-8 Before releasing a physician's core credentials data from its data
8-9 bank, the council must provide the practitioner up to 30 days to
8-10 review such data and request reconsideration or resolution of
8-11 errors in, or omissions of, date collected during the credentials
8-12 verification process.
8-13 Section 7.10. Verification of Credentials Data.
8-14 The primary and secondary source verification procedures used by
8-15 the council must meet the national standards as outlined by
8-16 national accrediting organizations and the Council must be
8-17 appropriately accredited by such national accrediting
8-18 organizations.
8-19 Section 7.11. Rules.
8-20 The board, in consultation with the council, shall adopt rules
8-21 necessary to develop and implement the standardized credentials
8-22 verification program established by this subsection.
8-23 Section 7.12. Confidentiality. The information received,
8-24 collected or stored by the Council is proprietary information and
8-25 is privileged and confidential and cannot be released except as
8-26 provided by this subchapter. The information received collected or
9-1 stored by the Council is not subject to the Open Records Law, Gov't
9-2 Code, Chapter 552.
9-3 Section 7.13. Appropriations, Grants and Donations.
9-4 In addition to any fees paid to the Council or funds appropriated
9-5 to the Council, the Council may receive and accept gifts, grants,
9-6 donations, and any other type of funds or things of value from any
9-7 source, including the United States Government and any private
9-8 source.
9-9 Section 7.14. Fees.
9-10 The Council in consultation with the board, shall charge and
9-11 collect fees in amounts necessary to cover its cost of operating
9-12 and administering its duties and functions under this subchapter.
9-13 The Council shall pay and otherwise compensate the board for any
9-14 and all of its expenses and services rendered on behalf of the
9-15 Council.
9-16 SECTION 2. The Council shall study the feasibility of adding
9-17 additional health care providers to credentials verification
9-18 services that it provides. The study shall include a cost estimate
9-19 and phase in requirements that may be necessary. The Council shall
9-20 report to the Speaker of the House and to the Lt. Governor no later
9-21 than December 1, 2000.
9-22 SECTION 3. The council shall appoint a task force no later
9-23 than January 5, 2000 to develop procedures to expand the
9-24 standardized credentials verification program to include office
9-25 site visits and medical chart reviews. The Task Force will report
9-26 back to the council no later than December 1, 2000, and the Council
10-1 shall report to the Speaker of the House and to the Lt. Governor by
10-2 December 31, 2000.
10-3 SECTION 4. This Act takes effect September 1, 1999.
10-4 SECTION 5. The Council shall make available the credentials
10-5 reports required by this act starting not later than July 1, 2000.
10-6 SECTION 6. The importance of this legislation and the
10-7 crowded condition of the calendars in both houses create an
10-8 emergency and an imperative public necessity that the
10-9 constitutional rule requiring bills to be read on three several
10-10 days in each house be suspended, and this rule is hereby suspended.