1-1     By:  Cain                                             S.B. No. 1618
 1-2           (In the Senate - Filed March 12, 1999; March 15, 1999, read
 1-3     first time and referred to Committee on Health Services;
 1-4     April 29, 1999, reported adversely, with favorable Committee
 1-5     Substitute by the following vote:  Yeas 5, Nays 0; April 29, 1999,
 1-6     sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 1618                   By:  Madla
 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
1-23     credentials data are collected, validated, maintained, and stored,
1-24     they need not 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.  CREDENTIALS VERIFICATION PROGRAM
1-29           Sec. 7.01.  DEFINITIONS.  In this subchapter:
1-30                 (1)  "Core credentials data" means the following data:
1-31                       (A)  identity information;
1-32                       (B)  all professional education;
1-33                       (C)  all professional training;
1-34                       (D)  licensure from Texas and other states or
1-35     jurisdictions of the United States; and
1-36                       (E)  Educational Commission for Foreign Medical
1-37     Graduates certification.
1-38                 (2)  "Credentials verification organization" means any
1-39     organization certified or accredited as a credentials verification
1-40     organization for the express purpose of collecting, verifying,
1-41     maintaining, storing, and providing to health care entities a
1-42     health care practitioner's verified credentials data, including all
1-43     corrections, updates, and modifications to such data, as authorized
1-44     by the physician.  For the purposes of this subdivision,
1-45     "certified" or "accredited" includes nationally recognized
1-46     accreditation organizations.
1-47                 (3)  "Health care entity" means:
1-48                       (A)  any health care facility or other health
1-49     care organization licensed or certified to provide approved medical
1-50     and allied health services in Texas;
1-51                       (B)  any entity licensed by the Texas Department
1-52     of Insurance as a prepaid health care plan or health maintenance
1-53     organization or as an insurer to provide coverage for health care
1-54     services through a network of providers;
1-55                       (C)  any health care provider entity accepting a
1-56     delegated credentialing function from a health maintenance
1-57     organization; or
1-58                       (D)  an association representing federally
1-59     qualified health centers, as defined by 42 U.S.C. Section
1-60     1396d(l)(2)(B).
1-61                 (4)  "Physician" means any person licensed or applying
1-62     for licensure under this Act based on the person's doctor of
1-63     medicine or doctor of osteopathy degree.
1-64           Sec. 7.02.  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.
 2-1     (a)  In accordance with the provisions of this section, the board
 2-2     shall develop standardized forms and guidelines for collecting,
 2-3     verifying, maintaining, and storing core credentials data and for
 2-4     releasing the data to health care entities or to the designated
 2-5     credentials verification organization authorized by the physician
 2-6     to receive the data.  Once the core credentials data are submitted
 2-7     to the board, the physician is not required to resubmit this
 2-8     initial data when applying for practice privileges with a health
 2-9     care entity.  However, each physician is responsible for providing
2-10     to the board within 30 days any corrections, updates, and
2-11     modifications to the core credentials data to ensure that all
2-12     credentialing data on the physician remains current.  In addition,
2-13     if no data has been reported, a physician must update annually the
2-14     physician's data on a form prescribed by the board.
2-15           (b)  The board shall develop standard forms for:
2-16                 (1)  initial reporting of core credentials data;
2-17                 (2)  authorizing release of core credentials data; and
2-18                 (3)  subsequent reporting of corrections, updates, and
2-19     modifications.
2-20           (c)  Any health care entity that employs, contracts with, or
2-21     credentials physicians must use the board to obtain core
2-22     credentials data for items for which the board is designated or
2-23     accepted as a primary source by a national accreditation
2-24     organization.  A health care entity may act through its designated
2-25     credentials verification organization.
2-26           (d)  Nothing in this section may be constructed to restrict
2-27     in any way the authority of a health care entity to approve or deny
2-28     an application for or renewal of hospital staff membership,
2-29     clinical privileges, or managed care network participation.
2-30           Sec. 7.03.  AVAILABILITY OF DATA COLLECTED.  The board shall
2-31     make available to a health care entity or its designated
2-32     credentials verification organization all core credentials data it
2-33     collects on a physician, including corrections, updates, and
2-34     modifications to the data, if authorized by the physician.  This
2-35     information shall be made available within 15 business days after
2-36     receipt of the request.
2-37           Sec. 7.04.  DUPLICATION OF DATA PROHIBITED.  (a)  A health
2-38     care entity is prohibited from collecting or attempting to collect
2-39     duplicate core credentials data from a physician if the information
2-40     is available from the board for items for which the board is
2-41     designated or accepted as a primary source by a national
2-42     accreditation organization.  Nothing in this section may be
2-43     construed to restrict the right of a health care entity to request
2-44     additional information not included in the core credentials data
2-45     file that is necessary in order for the health care entity to
2-46     credential the physician.  Any additional information required by
2-47     the health care entity's credentialing process may be collected
2-48     from the primary sources of that information either by the health
2-49     care entity or by its designated credentials verification
2-50     organization.
2-51           (b)  Effective September 1, 1999, a state agency may not
2-52     collect or attempt to collect duplicate core credentials data from
2-53     a physician if the information is already available from the board
2-54     for items for which the board is designated or accepted as a
2-55     primary source by a national accreditation organization.  Nothing
2-56     in this section may be construed to restrict the right of a state
2-57     agency to request additional information not included in the core
2-58     credentials data file but deemed necessary for the agency's
2-59     specific credentialing purposes.
2-60           Sec. 7.05.  LIABILITY.  No civil, criminal, or administrative
2-61     action may be instituted, and there shall be no liability, against
2-62     any health care entity or its designated credentials verification
2-63     organization because of the health care entity's or verification
2-64     organization's reliance on any data obtained from the board under
2-65     this subchapter.
2-66           Sec. 7.06.  REVIEW.  Before releasing a physician's core
2-67     credentials data from its data bank for the first time, the board
2-68     shall provide the physician 15 business days to review the data and
2-69     request reconsideration or resolution of errors in, or omissions
 3-1     of, data collected during the initial credentials verification
 3-2     process.  Any changes, comments, or clarifications made by the
 3-3     physician shall be noted and included with the information in the
 3-4     core credentials data.  The board shall notify the physician of any
 3-5     subsequent changes to the core credentials data when such changes
 3-6     are made or initiated by a person other than the physician.  A
 3-7     physician may request to review the data collected at any time
 3-8     after the initial release of information, but such request does not
 3-9     require the board to hold, release, or modify any information.
3-10           Sec. 7.07.  RULES.  The board shall adopt rules necessary to
3-11     develop and implement the standardized credentials verification
3-12     program established by this subchapter.
3-13           Sec. 7.08.  CONFIDENTIALITY.  The information received,
3-14     collected, maintained, or stored by the board under this subchapter
3-15     is privileged and confidential and cannot be released, including by
3-16     discovery or subpoena, except as provided by this subchapter or
3-17     otherwise authorized by law.
3-18           Sec. 7.09.  USE OF INDEPENDENT CONTRACTOR.  The board may
3-19     provide for the collecting, verifying, maintaining, storing, and
3-20     releasing of information through an independent contractor.  Any
3-21     agreement between the board and such contractor shall provide for
3-22     board oversight and confidentiality and be awarded through a
3-23     competitive bidding process.
3-24           Sec. 7.10.  APPROPRIATIONS, GRANTS, AND DONATIONS.  In
3-25     addition to any fees paid to the board or funds appropriated to the
3-26     board, the board may receive and accept gifts, grants, donations,
3-27     and any other type of funds or things of value from any source,
3-28     including the United States government and any private source.
3-29           Sec. 7.11.  FEES.  The board shall charge and collect fees
3-30     only in amounts necessary to recover the cost of operating and
3-31     administering the board's duties and functions under this
3-32     subchapter.  The board may waive a fee for a state agency that is
3-33     required to use the core credentials data and that is prohibited
3-34     from collecting duplicate data by Section 7.04 of this Act.
3-35           SECTION 3.  The Texas State Board of Medical Examiners is
3-36     required to implement the credentials verification program under
3-37     Subchapter G, Medical Practice Act (Article 4495b, Vernon's Texas
3-38     Civil Statutes), as added by this Act, only if the legislature
3-39     appropriates money specifically for that purpose.  If the
3-40     legislature does not appropriate money specifically for that
3-41     purpose, the board may, but is not required to, implement the
3-42     credentials verification program using other appropriations, gifts,
3-43     grants, or donations available for that purpose.
3-44           SECTION 4.  The Texas State Board of Medical Examiners shall
3-45     make available the credentials reports required by Subchapter G,
3-46     Medical Practice Act (Article 4495b, Vernon's Texas Civil
3-47     Statutes), as added by this Act, starting not sooner than September
3-48     1, 2001.  A health care entity is not required to use the board's
3-49     core credentials data until such data is available from the board
3-50     for items for which the board is designated or accepted as a
3-51     primary source by a national accreditation organization.
3-52           SECTION 5.  This Act takes effect September 1, 1999.
3-53           SECTION 6.  The importance of this legislation and the
3-54     crowded condition of the calendars in both houses create an
3-55     emergency and an imperative public necessity that the
3-56     constitutional rule requiring bills to be read on three several
3-57     days in each house be suspended, and this rule is hereby suspended.
3-58                                  * * * * *