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.