By Janek H.B. No. 576
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the standardization of credentialing of physicians and
1-3 providers.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. The legislature recognizes that an efficient and
1-6 effective physician and provider credentialing program helps to
1-7 ensure access to quality health care and also recognizes that
1-8 physician and provider 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 and provider credentialing
1-12 activities is unnecessarily costly and cumbersome for both the
1-13 practitioner and the entity granting practice privileges.
1-14 Therefore, it is the intent of the legislature that a single
1-15 mandatory credentials collection program be established [which
1-16 provides that once a] for the collection of a physician's and
1-17 provider's core credentials data. [are collected, validated,
1-18 maintained, and stored they need not be collected again.]
1-19 SECTION 2. Subchapter G., The Medical Practice Act (Article
1-20 4495b, Vernon's Texas Civil Statutes) is amended as follows:
1-21 SUBCHAPTER G. PHYSICIAN AND PROVIDER CREDENTIALING
1-22 Sec. 7.01. DEFINITIONS. In this subchapter:
2-1 (1) "Advisory Board" means the Advisory Board on
2-2 Provider Credentialing Information.
2-3 (2) "Board" means the Texas State Board of Medical
2-4 Examiners.
2-5 (3) "Certified or accredited" means approved by a
2-6 national accrediting organization used to assess and certify any
2-7 credentials verification program, entity, or organization that
2-8 verifies the credentials of any physician or provider.
2-9 [(1)] (4) "Core credentials data" means
2-10 (a) data that is primary source verified and includes, but
2-11 is not limited to, a physician's and provider's:
2-12 [(A)] (1) name and other demographic data;
2-13 [(B)] (2) professional education;
2-14 [(C)] (3) professional training;
2-15 [(D)] (4) [licenses; ]]Lprimary source verified
2-16 licensure; current valid license;
2-17 [(E)] (5) Educational Commission for Foreign
2-18 Medical Graduates certification if appropriate;
2-19 (6) board certification, if applicable;
2-20 (7) Drug Enforcement Administration certification;
2-21 (8) Texas Department of Public Safety Controlled
2-22 Substances Permit certification;
2-23 (9) Professional liability insurance;
2-24 (10) National Practitioner Data Bank information; and
2-25 (11) License sanctions and Medicare and Medicaid
2-26 sanctions as available.
3-1 (b) For health care facilities, in addition to (a)(1)
3-2 through (10) of this section, core credentials data include
3-3 accreditation by a national accrediting organization and Medicare
3-4 certification as available.
3-5 (c) The board by rule may add core credentialing data
3-6 elements as necessary.
3-7 (5) "Department" means Texas Department of Insurance.
3-8 [(2)] (6) "Designated Credentials Verification
3-9 Organization" means an organization that is certified or accredited
3-10 and is organized to collect, verify, maintain, store, and provide
3-11 to health care entities a health care [practitioner's] physician's
3-12 and provider's verified credentials data including all corrections,
3-13 updates, and modifications to that data and that contracts with the
3-14 board, in consultation with the advisory committee, to carry out
3-15 the duties delegated by the board and advisory committee under this
3-16 subchapter. [For purposes of this subdivision, "certified" or
3-17 "accredited" includes certification or accreditation by a
3-18 nationally recognized accreditation organization.]
3-19 [(3)] (7) "Health care entity" means:
3-20 (A) a health care facility or other health care
3-21 organization licensed or certified to provide approved medical and
3-22 allied health services in this state;
3-23 (B) an entity licensed by the Texas Department
3-24 of Insurance as a prepaid health care plan or health maintenance
3-25 organization or as an insurer to provide coverage for health care
3-26 services through a network of providers; [or]
4-1 (C) [a health care provider entity] an entity
4-2 accepting delegated credentialing functions [from a health
4-3 maintenance organization].; or
4-4 (D) a preferred provider organization as defined
4-5 in this section.
4-6 (8) "Initial credentials verification" means the
4-7 process by which Designated Credentials Verification Organization
4-8 verifies the credentials of a physician or provider the first time
4-9 the physician or provider applies for credentialing.
4-10 (9) "Institutional credentials verification" means the
4-11 process by which a Designated Credentials Verification Organization
4-12 verifies the credentials of a health care facility licensed or
4-13 certified to provide approved medical and allied health services in
4-14 this state.
4-15 (10) "National Accrediting Organization" means an
4-16 organization that awards accreditation or certification to
4-17 hospitals, managed care organizations, other health care
4-18 organizations or credentials verification organizations including,
4-19 but not limited to, the Joint Commission on Accreditation of
4-20 Healthcare Organizations the National Committee for Quality
4-21 Assurance and the American Accreditation HealthCare Commission
4-22 (also known as the Utilization Review Accreditation Commission.)
4-23 (11) "Physician" means a holder of or applicant for a
4-24 license under [this Act] Chap. 155, Occupations Code, as a medical
4-25 doctor or doctor of osteopathy.
4-26 (12) "Preferred provider organization" means an entity
5-1 that contracts with providers or provider groups for the purpose of
5-2 forming a health services network as defined in Art. 3.70-3C(10),
5-3 Texas Insurance Code.
5-4 (13) "Primary source verification" means verification
5-5 of professional qualifications based on evidence obtained directly
5-6 from the issuing source of the applicable qualification or other
5-7 sources otherwise deemed as primary source verification.
5-8 (14) "Provider" means any person other than a
5-9 physician including a licensed doctor of chiropractic, advanced
5-10 practice nurse, dentist, pharmacist, optometrist, registered
5-11 optician, pharmacy, hospital, or other institution or organization
5-12 or person that is licensed or otherwise authorized to provide a
5-13 health care service in this state.
5-14 (15) "Reasonable fees" means fees in amounts necessary
5-15 to cover the cost plus one percent of operating and administering
5-16 this subchapter.
5-17 (16) "Recredentialing" means the process by which a
5-18 Designated Credentials Verification Organization verifies the
5-19 credentials of a physician or provider whose core data including
5-20 all corrections, updates and modifications thereto, are currently
5-21 on file with that entity on a periodic basis.
5-22 Sec. 7.01A. ASSOCIATIONS. Each provision of this Act that
5-23 applies to a health care entity also applies to an association that
5-24 represents federally qualified health centers. For purposes of
5-25 this section, "federally qualified health center" has the meaning
5-26 assigned by 42 U.S.C. Section 1396d(1)(2)(B), and its subsequent
6-1 amendments.
6-2 Sec. 7.02. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.
6-3 [(a) The board shall develop standardized forms and guidelines for
6-4 and administer:]
6-5 [(1) the collection, verification, correction,
6-6 updating, modification, maintenance, and storage of information
6-7 relating to physician credentials; and]
6-8 [(2) the release of that information to health care
6-9 entities or designated credentials verification organizations
6-10 authorized by the physician to receive that information.]
6-11 (a) The board, in consultation with the advisory committee,
6-12 may enter into a memorandum of understanding with the appropriate
6-13 state agency or agencies as it deems necessary to develop the
6-14 standardized credentials verification program. The board is not
6-15 required to seek assistance from outside agencies for the
6-16 development of the standardized credentials verification program
6-17 but may do so at its discretion. The board shall appoint an
6-18 advisory committee as defined in this subtitle to advise the board
6-19 in developing rules and regulations to administer this subchapter
6-20 as authorized by Section 2001.031, Government Code. The advisory
6-21 committee's deliberations shall be subject to the open meetings
6-22 law. The board, in consultation with the advisory committee, shall
6-23 retain all policymaking authority over the standardized credentials
6-24 verification program and shall adopt rules as necessary to
6-25 implement this subtitle.
6-26 [(b) Except as provided by Subsection (c), a physician whose
7-1 core credentials data is submitted to the board is not required to
7-2 resubmit the data when applying for practice privileges with a
7-3 health care entity.]
7-4 (b) The advisory committee shall include, but not be limited
7-5 to, the public insurance counsel and one representative of each of
7-6 the following: certified credentials verification organizations,
7-7 insurance companies, health maintenance organizations, preferred
7-8 provider organizations, employers, consumer organizations,
7-9 physicians, including a medical doctor and a doctor of osteopathy,
7-10 dentists, hospitals and other physicians or providers or
7-11 organizations as determined to be necessary by the board and
7-12 advisory committee.
7-13 [(c) a physician shall:]
7-14 [(1) provide to the board any correction, update, or
7-15 modification of the physician's core credentials data not later
7-16 than the 30th day after the date the data on file is no longer
7-17 accurate;]
7-18 [(2) resubmit the physician's core credentials data
7-19 annually if the physician did not submit a correction, update, or
7-20 modification during the preceding year.]
7-21 (c) The board, in consultation with the advisory committee,
7-22 shall enter into a memorandum of understanding with the General
7-23 Services Commission to develop standardized guidelines for the
7-24 procurement and maintenance of all contracts with the Designated
7-25 Credentials Verification Organizations. The memorandum of
7-26 understanding shall set forth standardized guidelines for issuing a
8-1 contract to another Designated Credentials Verification
8-2 Organization in the event that the Designated Credentials
8-3 Verification Organization initially issued a contract fails to meet
8-4 its contractual obligation. The procurement process by which a
8-5 contract is issued to the Designated Credentials Verification
8-6 Organization shall comply with all federal and state laws or
8-7 regulations. In administering the system, the board, in
8-8 consultation with the advisory committee, shall contract with one
8-9 regionally based accredited credentials verification organization
8-10 and shall comply with the standards and registration requirements
8-11 set forth under Sec. 7.09 of this subchapter.
8-12 [(d) A health care entity that employs, contracts with, or
8-13 credentials physicians must use the board to obtain core
8-14 credentials data for items for which the board is designated or
8-15 accepted as a primary source by a national accreditation
8-16 organization. A health care entity may act through its designated
8-17 credentials verification organization.]
8-18 (d) The board, in consultation with the advisory committee,
8-19 shall develop standardized forms for initial credentialing and
8-20 recredentialing. In developing standardized forms, the board, in
8-21 consultation with the advisory committee, shall consider the design
8-22 and format of standardized credentialing and recredentialing forms
8-23 used by a health care entity at the time the board is developing
8-24 its standardized forms. The board shall also consider any
8-25 applicable standards or guidelines from the National Committee for
8-26 Quality Assurance (NCQA) in developing standardized forms. The
9-1 board, in consultation with the advisory committee, shall oversee
9-2 the following:
9-3 (1) the certification, selection and operation of
9-4 accredited or certified credential verification organizations, to
9-5 be named "Designated Credentials Verification Organizations," to
9-6 carry out the duties delegated by the board and advisory committee
9-7 under this subchapter;
9-8 (2) the suspension and revocation of an accredited or
9-9 certified Designated Credential Verification Organization's
9-10 contract with the board;
9-11 (3) charging a reasonable fee as set forth under Sec.
9-12 7.09 to access the core credential data pursuant to the
9-13 requirements of Chapter 316, Government Code and as set forth by
9-14 the board in consultation with the advisory committee. The board,
9-15 in consultation with the advisory committee, may waive a fee for a
9-16 state agency that is required to obtain core credentials data from
9-17 the Designated Credentials Verification Organization and that is
9-18 prohibited by Sec. 7.05 of this subchapter from collecting
9-19 duplicate data;
9-20 (4) providing ongoing oversight of the Designated
9-21 Credentials Verification Organization to ensure continued
9-22 compliance with the contract between the board and the Designated
9-23 Credentials Verification Organization as set forth under Sec. 7.08,
9-24 this article and the standards and rules adopted under this
9-25 article. The General Services Commission shall assist the board and
9-26 the advisory committee with the administrative oversight of the
10-1 contract;
10-2 (5) developing standardized forms to be used by the
10-3 physician or provider for the initial reporting of core credentials
10-4 data, for the physician or provider to authorize the release of
10-5 core credentials data, for the core credentials report to be sent
10-6 to requesting health care entities, and for the subsequent
10-7 reporting of corrections, updates, and modifications to any
10-8 document; and
10-9 (6) the Designated Credentials Verification
10-10 Organization's collection of all core credentials data as defined
10-11 in this subchapter.
10-12 (e) Each physician and provider required to be credentialed
10-13 by a health care entity as defined in this subchapter for purposes
10-14 of serving on a health care entity's physician or provider network
10-15 or for purposes of obtaining and maintaining hospital privileges
10-16 shall:
10-17 (1) report all core credentials data to the Designated
10-18 Credentials Verification Organization by completing. a standardized
10-19 application; and
10-20 (2) notify the Designated Credentials Verification
10-21 Organization within 45 business days of any corrections, updates or
10-22 modifications to the core credentials data by submitting the data
10-23 directly on forms promulgated by the board in consultation with the
10-24 advisory committee.
10-25 (f) The Designated Credentials Verification Organization
10-26 shall:
11-1 (1)(a) be certified or accredited by the National
11-2 Committee for Quality Assurance, and shall maintain such
11-3 certification without interruption through the term of the contract
11-4 as a condition of registration for all of the credentialing
11-5 elements currently addressed in the National Committee for Quality
11-6 Assurance Credentialing Verification Organization certification
11-7 program and be fully accredited or certified as a credentials
11-8 verification organization by [a] the appropriate nationally
11-9 recognized accrediting organization as specified in this
11-10 subchapter; and
11-11 (b) be fully accredited or certified as a credentials
11-12 verification organization by at least one other national
11-13 accrediting organization, provided that such accreditation shall
11-14 not cause a Designated Credentials Verification Organization to
11-15 vary from compliance with National Committee for Quality Assurance
11-16 standards and guidelines.
11-17 (2) timely comply with the requirements of this
11-18 subchapter, pursuant to rules adopted by the board in consultation
11-19 with the advisory committee;
11-20 (3) maintain liability insurance appropriate to meet
11-21 the certification;
11-22 (4) provide the physician's or provider's core data,
11-23 including all corrections, updates, and modifications only with the
11-24 authorization of the physician or provider;
11-25 (5) be capable of electronically receiving and
11-26 submitting data in a format to be determined by the board in
12-1 consultation with the advisory committee;
12-2 (6) be prohibited from releasing a physician's or
12-3 provider's core credentials data to any entity other than the
12-4 health care entity authorized by the physician or provider to
12-5 collect such data;
12-6 (7) establish guidelines for the transferring,
12-7 transmitting and storage of a physician's or provider's core
12-8 credentials data; and
12-9 (8) meet all National Committee for Quality Assurance
12-10 requirements, including but not limited to, those set forth under
12-11 subparagraph (f)(1)(a) of this section.
12-12 (g) The Designated Credentials Verification Organization
12-13 must notify the board, pursuant to rules established by the board,
12-14 upon receiving notice of the National Committee for Quality
12-15 Assurance's suspension or revocation of its certification as a
12-16 credential verification organization, and upon receiving notice of
12-17 the suspension or revocation of its certification or accreditation
12-18 with any applicable national accrediting organization. Failure of
12-19 the Designated Credential Verification Organization to do so may
12-20 result in the board's assessment of sanctions pursuant to Sec. 7.10
12-21 of this subchapter in addition to denial of an application,
12-22 termination of contract, or revocation or suspension pursuant to
12-23 Sec. 7.08(b).
12-24 Sec. 7.03. FURNISHING OF DATA TO HEALTH CARE ENTITY. [Not
12-25 later than the 15th business day after the date the board receives
12-26 a request for the data, the board shall make available to a health
13-1 care entity or its Designated Credentials Verification Organization
13-2 all core credentials data it collects on a physician, including any
13-3 correction, update, or modification of that data, if authorized by
13-4 the physician.] A health care entity must use the Designated
13-5 Credentials Verification Organization to obtain core credentials
13-6 data. The health care entity may use another accredited or
13-7 certified credentials verification organization to obtain
13-8 additional verified data it may require to meet its credentialing
13-9 or clinical privileging requirements or may obtain such data
13-10 utilizing its own resources. This section does not restrict or
13-11 modify the authority of a health care entity to approve or deny an
13-12 original or renewal application for hospital staff membership,
13-13 clinical privileges or managed care network participation pursuant
13-14 to its own criteria. The board, in consultation with the advisory
13-15 committee, shall establish the length of time within which the
13-16 Designated Credentials Verification Organization must respond to a
13-17 request for all core credentials data it has collected on a
13-18 physician or provider including any correction, update, or
13-19 modification of that data.
13-20 Sec. 7.04. REVIEW OF DATA BY PHYSICIAN OR PROVIDER. (a) If
13-21 the data obtained from other sources varies substantially from the
13-22 data provided by the physician or provider to the Designated
13-23 Credentials Verification Organization, before releasing a
13-24 physician's or provider's core credentials data from its data bank
13-25 for the first time or following a change in the data from its data
13-26 bank, the [board] Designated Credentials Verification Organization
14-1 shall provide to the affected physician or provider 15 business
14-2 days to review the data and request reconsideration or resolution
14-3 of errors in or omissions from the data. The [board] Designated
14-4 Credentials Verification Organization shall include with the data
14-5 any change or clarification made by the physician or provider.
14-6 (b) The [board] Designated Credentials Verification
14-7 Organization shall notify a physician or provider of any change to
14-8 the physician's or provider's core credentials data when a change
14-9 is made or initiated by a person other than the physician or
14-10 provider.
14-11 (c) A physician or provider may request to review the
14-12 physician's or provider's core credentials data collected by the
14-13 Designated Credentials Verification Organization at any time after
14-14 the initial release of information, but the [board] Designated
14-15 Credentials Verification Organization is not required by virtue of
14-16 a request to hold, release, or modify any information.
14-17 Sec. 7.05. DATA DUPLICATION PROHIBITED. (a) A health care
14-18 entity may not collect or attempt to collect duplicate core
14-19 credentials data from a physician or provider for credentialing
14-20 purposes if the information is already on file with the [board]
14-21 Designated Credentials Verification Organization. This section does
14-22 not restrict the right of a health care entity to request
14-23 additional information not included in the core credentials data on
14-24 file with the [board] Designated Credentials Verification
14-25 Organization that is necessary for the health care entity to
14-26 credential the physician or provider pursuant to the health care
15-1 entity's own standards or criteria. [A health care entity or its
15-2 Designated Credentials Verification Organization may collect any
15-3 additional information required by the health care entity's
15-4 credentialing process from a primary source of that information.]
15-5 (b) A state agency may not collect [or attempt to collect]
15-6 duplicate core credentials data from a physician or provider if the
15-7 information is already on file with the [board] Designated
15-8 Credentials Verification Organization. This section does not
15-9 restrict the right of a state agency to request additional
15-10 information not included in the core credentials data on file with
15-11 the [board] Designated Credentials Verification Organization that
15-12 the agency considers necessary for its specific credentialing
15-13 purposes.
15-14 (c) This subtitle does not apply to a professional licensing
15-15 board.
15-16 [(c)] (d) The [board] Designated Credentials Verification
15-17 Organization [by rule may] shall be authorized to except from
15-18 Subsections (a) and (b) of this section a request for core
15-19 credentials data that is necessary for a health care entity to
15-20 provide temporary privileges during the credentialing process.
15-21 Sec. 7.06. IMMUNITY. [A health care entity or its designated
15-22 credentials verification organization is immune from liability
15-23 arising from its reliance on data furnished by the board under this
15-24 subchapter.] (a) The following are immune from civil liability:
15-25 (1) A health care entity that credentials a physician
15-26 or provider based on data furnished by the Designated Credentials
16-1 Verification Organization.
16-2 (2) A member, employee, or agent of the board who
16-3 takes an action or makes a recommendation within the scope of the
16-4 functions of the board provided under this subchapter if that
16-5 member, employee, or agent acts without malice and in the
16-6 reasonable belief that the action or recommendation is warranted by
16-7 the facts known to that person.
16-8 [Sec. 7.07. RULES. The board shall adopt rules as necessary
16-9 to develop and implement the standardized credentials verification
16-10 program established by this subchapter.]
16-11 Sec. [7.08] 7.07. CONFIDENTIALITY. (a) The information
16-12 collected, transferred, transmitted, maintained, or stored by the
16-13 Designated Credentials Verification Organization under this
16-14 subchapter is privileged and confidential and not subject to
16-15 discovery, subpoena, or other means of legal compulsion for its
16-16 release or to disclosure under Chapter 552, Government Code, except
16-17 as otherwise provided by this subchapter.
16-18 (b) If a Designated Credentialing Verification Organization
16-19 fails to meet its contractual obligations, all core credentials
16-20 data, records and other information collected, maintained or stored
16-21 by that Designated Credentialing Verification Organization shall be
16-22 transferred to the board and shall be considered privileged and
16-23 confidential and not subject to discovery, subpoena, or other means
16-24 of legal compulsion for its release or to disclosure under Chapter
16-25 552, Government Code, except as otherwise provided by this
16-26 subchapter. The board, in consultation with the advisory
17-1 committee, shall reassign all core credentials data, records and
17-2 other information collected to a Designated Credentialing
17-3 Verification Organization selected by the board and advisory
17-4 committee.
17-5 (c) A Designated Credentialing Verification Organization
17-6 shall be prohibited from releasing a physician's or provider's core
17-7 credentials data without authorization to any entity other than the
17-8 health care entity authorized by the physician or provider to
17-9 collect such data or to a national accrediting body certifying or
17-10 accrediting the Designated Credentialing Verification Organization.
17-11 (d) A health care entity shall be prohibited from
17-12 transferring a physician's or provider's core credentials data to a
17-13 health care entity's affiliate company or any other company
17-14 associated with the health care entity unless the physician or
17-15 provider specifically authorizes the release of such information.
17-16 Sec. [7.09.] 7.08 [USE OF INDEPENDENT CONTRACTOR. The board
17-17 may contract with an independent contractor to collect, verify,
17-18 maintain, store, or release information. The contract must provide
17-19 for board oversight and for the confidentiality of the information.
17-20 If the board contracts with an independent entity that is not a
17-21 governmental unit to carry out the provisions of this subchapter,
17-22 the independent entity is not immune from liability.] STANDARDS AND
17-23 REGISTRATION. (a) It is the intent of the legislature that the
17-24 board and advisory committee maximize the use of private resources
17-25 in administering the credentialing verification system created
17-26 under this chapter. In administering the system, the board, in
18-1 consultation with the advisory committee, shall contract with one
18-2 regionally based accredited credentials verification organization.
18-3 More than one region may be established by the board, in
18-4 consultation with the advisory committee, but shall not exceed four
18-5 regions within the State of Texas. The board, in consultation with
18-6 the advisory committee, may not exceed more than one accredited
18-7 credentials verification organization per region. The board, in
18-8 consultation with the advisory committee, will coordinate procuring
18-9 and selecting one contractor per region as defined in a memorandum
18-10 of understanding with the General Services Commission. The General
18-11 Services Commission shall assist the board and advisory committee
18-12 with the design, development and administration of the contract
18-13 with the Designated Credentialing Verification Organization.
18-14 (b) The board, in consultation with the advisory committee,
18-15 may charge the Designated Credentials Verification Organizations a
18-16 reasonable registration fee and registration renewal fee not to
18-17 exceed an amount sufficient to cover its actual expenses in
18-18 providing and enforcing such registration. The board, in
18-19 consultation with the advisory committee, shall establish by rule
18-20 for biennial renewal of such registration. If the board, in
18-21 consultation with the advisory committee, determines that a
18-22 Designated Credentials Verification Organization fails to maintain
18-23 full accreditation or certification, provide data as authorized by
18-24 the physician or provider, or comply with the prohibition against
18-25 collection of duplicate core credentials data from a provider or
18-26 physician, the board, in consultation with the advisory committee
19-1 may deny an application for renewal of registration, revoke,
19-2 suspend registration or terminate the contract.
19-3 (c) If the board determines that a Designated Credentials
19-4 Verification Organization is insolvent, fails to meet its
19-5 contractual obligations or fails to meet the standards set forth
19-6 under Sec. 7.08(a), the board, in consultation with the advisory
19-7 committee, may terminate the contract and reassign the Designated
19-8 Credentials Verification Organization's duties and responsibilities
19-9 to another Designated Credentials Verification Organization
19-10 selected by the board and advisory committee. The General Services
19-11 Commission shall assist the board and advisory committee with the
19-12 reassignment of a contract. Such information transferred to the
19-13 board and advisory committee for reassignment shall be subject to
19-14 Sec. 7.07 of this subchapter.
19-15 (d) The board, in consultation with the advisory committee
19-16 and with assistance from the General Services Commission, shall
19-17 procure its contract with the Designated Credentials Verification
19-18 Organizations through a competitive procurement process in
19-19 compliance with all applicable federal and state laws or
19-20 regulations.
19-21 Sec. [7.10.] 7.09. FEES FOR HEALTH CARE ENTITIES ACCESSING
19-22 INFORMATION. (a) The board, in consultation with the advisory
19-23 committee, shall charge and collect reasonable fees from a health
19-24 care entity accessing information from a Designated Credentials
19-25 Verification Organization. Such fees shall be in amounts necessary
19-26 to cover the cost of operating and administering this subchapter.
20-1 [charge and collect fees in amounts necessary to cover its cost of
20-2 operating and administering its duties and functions under this
20-3 subchapter.]
20-4 (b) The board, in consultation with the advisory committee,
20-5 may waive a fee for a state agency that is required to obtain core
20-6 credentials data from the [board] Designated Credentials
20-7 Verification Organization and that is prohibited by Section 7.05 of
20-8 this Act from collecting duplicate data.
20-9 Sec. 7.10. SANCTIONS FOR FAILURE TO PERFORM. (a) The board,
20-10 in consultation with the advisory committee, shall impose sanctions
20-11 against physicians and providers for failure to meet the
20-12 performance requirements set forth under this subchapter.
20-13 (b) The board, in consultation with the advisory committee,
20-14 shall impose sanctions against the Designated Credentialing
20-15 Verification Organization for failure to meet the collection and
20-16 performance requirements set forth under this subchapter.
20-17 (c) The board, in consultation with the advisory committee,
20-18 shall adopt rules necessary to implement this section.
20-19 Sec. 7.11. GIFTS, GRANTS, AND DONATIONS. In addition to any
20-20 fees paid to the board or money appropriated to the board, the
20-21 board may receive and accept a gift, grant, donation, or other
20-22 thing of value from any source, including the United States or a
20-23 private source.
20-24 Sec. 7.12. STATUTES RELATING TO CREDENTIALING. (a) This
20-25 subchapter shall supercede all other statutes and rules as set
20-26 forth under Tex. Ins. Code, Art. 20A., relating to credentialing,
21-1 recredentialing and primary verification.
21-2 Sec. 7.13. COMPLAINTS AGAINST A DESIGNATED CREDENTIALS
21-3 VERIFICATION ORGANIZATION. (a) The Designated Credentials
21-4 Verification Organization shall report quarterly to the board and
21-5 advisory committee all complaints received from physicians,
21-6 providers and health care entities.
21-7 (b) The Designated Credentials Verification Organization
21-8 shall develop a form to standardize information concerning
21-9 complaints made to the Designated Credentials Verification
21-10 Organization.
21-11 (c) The Designated Credentials Verification Organization
21-12 shall prescribe information to be provided to a physician, provider
21-13 or health care entity when a complaint is made by a physician,
21-14 provider or health care entity.
21-15 (d) The Designated Credentials Verification Organization
21-16 shall provide reasonable assistance to a person who wishes to file
21-17 a complaint with the Designated Credentials Verification
21-18 Organization.
21-19 SECTION 3. The Texas State Board of Medical Examiners shall
21-20 implement this Act only if the legislature appropriates money
21-21 specifically for that purpose. If the legislature does not
21-22 appropriate money specifically for that purpose, the board may
21-23 implement this Act using other appropriations, gifts, grants, or
21-24 donations available for that purpose.
21-25 SECTION 4. (a) Except as provided by Section 3 of this Act,
21-26 not later than September 1, [2001] 2002, the [Texas State Board of
22-1 Medical Examiners] board, in consultation with the advisory
22-2 committee, shall make available the core credentials data required
22-3 by this Act.
22-4 (b) A health care entity is not required to [use]
22-5 participate in the [board's core credentials data] Standardized
22-6 Credentials Verification Program until September 1, [2001] 2002 at
22-7 which time the Designated Credentials Verification Organization
22-8 from which the health care entity will be collecting core data from
22-9 must be fully operational, have core data available, and meet all
22-10 contractual and statutory requirements under this subchapter. If
22-11 the Designated Credentials Verification Organization is not fully
22-12 operational on such date, the health care entity shall not be
22-13 required to collect core data from the Designated Credentials
22-14 Verification Organization until the board, in consultation with the
22-15 advisory committee, determines that the Designated Credentials
22-16 Verification Organization is fully operational.
22-17 SECTION 5. Amend Art. 20A.37, Texas Insurance Code, as
22-18 follows:
22-19 (1) The department shall not require site visits for
22-20 initial credentialing to be performed by clinical personnel.
22-21 (2) The department shall not require that a health
22-22 care entity maintain at all times evidence of current licensure and
22-23 appropriate certificates including but not limited to Medicare
22-24 certification.
22-25 (3) The department shall require that when a health
22-26 care entity is conducting site visits, the health care entity will
23-1 evaluate a site's accessibility, appearance, space, medical or
23-2 dental record keeping practices, availability of appointment and
23-3 confidentiality procedures but not the appropriateness of
23-4 equipment.
23-5 (4) The department shall not require that site visits
23-6 in the offices of high volume specialists be performed based on the
23-7 volume of visits to such offices.
23-8 (5) The department shall not require that site visits
23-9 be performed for recredentialing of any physician or provider.
23-10 (6) The department shall prohibit health maintenance
23-11 organizations and preferred provider organizations from collecting
23-12 duplicate core credentials data from physicians or providers with
23-13 whom they contract once the core credentials data have been
23-14 collected from the Designated Credentials Verification
23-15 Organization.
23-16 SECTION [5] 6. This Act takes effect September 1, [1999]
23-17 2001.
23-18 SECTION [6] 7. The importance of this legislation and the
23-19 crowded condition of the calendars in both houses create an
23-20 emergency and an imperative public necessity that the
23-21 constitutional rule requiring bills to be read on three several
23-22 days in each house be suspended, and this rule is hereby suspended.