SRC-CTC S.B. 1143 77(R)   BILL ANALYSIS


Senate Research Center   S.B. 1143
77R9062 TBy: Carona
Business & Commerce
3/16/2001
As Filed


DIGEST AND PURPOSE 

Currently, all contracts between health maintenance organizations and
physicians or other providers require credentialing.  The initial
credentialing process includes an application, verification of information,
and a site visit.  Texas has not updated the standards on credentialing
health maintenance organizations to stay in line with the National
Committee for Quality Assurance (NCQA).  Medicaid and Medicare
credentialing standards are based on NCQA standards.  As proposed, S.B.
1143 applies NCQA standards for health maintenance organizations to move
Texas requirements in line with national standards. 

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a
state officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Article 20A.37, Insurance Code, to require the Texas
Department of Insurance (department), in regard to a process for selection
and retention of affiliated providers implemented and performed by a health
maintenance organization (HMO) in accordance with this article, to: 

 _not require site visits for initial credentialing to be performed by
clinical personnel; 

_require an HMO to primary verify that a physician's license to practice,
and other required certificates such as DPS, DEA, and Medicare, are valid
and current at the time of initial credentialing and every recredentialing,
but shall not be required to verify validity or currency of license or
certificates during the interval between scheduled credentialing as
required by National Committee for Quality Assurance (NCQA); 

_require that when an HMO is conducting site visits, including evaluation
of the quality of encounter notes, the HMO will evaluate a site's
accessibility, appearance, space, medical or dental record keeping
practices, availability of appointment and confidentiality procedures but
not the appropriateness of equipment; 

 _not require that site visits be performed in the offices of high volume
specialists; 

 _not require that site visits be performed for recredentialing of any
physician or provider; 

_not require the HMO to formally recredential physicians and providers more
frequently than every three years; 

_conform regulations, except as otherwise required by law, governing
credentialing to standards promulgated and periodically revised by NCQA. 

SECTION 2.  Effective date: September 1, 2001.