SRC-CTC, MWN S.B. 544 77(R)BILL ANALYSIS Senate Research CenterS.B. 544 By: Brown, J. E. "Buster" Business & Commerce 6/12/2001 Enrolled DIGEST AND PURPOSE The requirement for health maintenance organizations (HMOs) to cover health risk assessment screenings is found in the Administrative Code but is not a statutory requirement. As proposed, S.B. 544 mandates, by statute, that HMOs include periodic health evaluations for each adult enrollee in the basic health care services provided under certain coverage. RULEMAKING AUTHORITY Rulemaking authority is expressly granted to the commissioner of insurance in SECTION 3 (Article 21.58D) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Chapter 20A, Insurance Code, (The Texas Health Maintenance Organization Act) by adding Section 9B, as follows: Sec. 9B. PERIODIC HEALTH EVALUATIONS REQUIRED. (a) Requires the basic health care services provided under an evidence of coverage to include periodic health evaluations for each adult enrollee. (b) Requires the services provided under this section to include a health risk assessment at least once every three years and, for a female enrollee, an annual wellwoman examination provided in accordance with Article 21.53D of this code, as added by Chapter 912 (Access to Obstetrical or Gynecological Health Care), Acts of the 75th Legislature, Regular Session, 1997. (c) Provides that this section does not apply to an evidence of coverage for limited health care service plan or a single health care service plan. SECTION 2. Amends The Texas Health Maintenance Organization Act (Chapter 20A, V.T.C.S.), by adding Section 39, as follows: Sec. 39. CREDENTIALING OF PHYSICIANS AND PROVIDERS. (a) Requires rules adopted by the commissioner of insurance under Section 37 of this Act that relate to implementation and maintenance by a health maintenance organization of a process for selecting and retaining affiliated physicians and providers to comply with certain standards. (b) Requires the commissioner to require a health maintenance organization to verify that a physician's license to practice medicine and any other certificate the physician is required to hold, including a certificate issued by the Department of Public Safety of the State of Texas or the federal Drug Enforcement Agency or a certificate issued under the Medicare program, is valid as of the date of initial credentialing and on the date of each recredentailing. (c) Requires the commissioner to require a health maintenance organization that conducts a site visit for the purpose of initial credentialing to evaluate during the visit a site's accessibility, appearance, space, medical, or dental record keeping practices, availability of appointments, and confidentiality procedures. Prohibits the commissioner from requiring the health maintenance organization to evaluate the appropriateness of equipment during the state visit. (d) Prohibits the commissioner from requiring that a health maintenance organization perform certain procedures. (e) Provides that this section does not preclude a health maintenance organization from performing a site visit of a physician or provider at any time for cause, including a complaint made by a member or another external complaint made to the health maintenance organization. SECTION 3. Amends Chapter 21E, Insurance Code, by adding Article 21.58D, as follows: Art. 21.58D. STANDARDIZED FORM FOR VERIFICATION OF PHYSICIAN CREDENTIALS. Sec. 1. DEFINITION. Defines "physician." Sec. 2. STANDARDIZED FORM. (a) Requires the commissioner by rule to perform certain procedures. (b) Requires the commissioner, in adopting a form under Subsection (a) of this section, to consider any credentialing application form that is widely used in this state. SECTION 4. (a) Requires the Texas State Board of Medical Examiners to study the establishment of a program for standardized credentials verification through using a credentialing information system. (b) Requires the board, not later than January 1, 2003, to report on its recommendations and furnish the report to certain persons. SECTION 5. Effective date: September 1, 2001. Makes application of Section 1 prospective to January 1, 2002.