1-1 AN ACT
1-2 relating to requiring the provision of periodic health evaluations
1-3 and credentialing of physicians and health care providers by health
1-4 maintenance organizations and to the verification of physician
1-5 credentials.
1-6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-7 SECTION 1. The Texas Health Maintenance Organization Act
1-8 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
1-9 Section 9B to read as follows:
1-10 Sec. 9B. PERIODIC HEALTH EVALUATIONS REQUIRED. (a) The
1-11 basic health care services provided under an evidence of coverage
1-12 must include periodic health evaluations for each adult enrollee.
1-13 (b) The services provided under this section must include a
1-14 health risk assessment at least once every three years and, for a
1-15 female enrollee, an annual well-woman examination provided in
1-16 accordance with Article 21.53D of this code, as added by Chapter
1-17 912, Acts of the 75th Legislature, Regular Session, 1997.
1-18 (c) This section does not apply to an evidence of coverage
1-19 for a limited health care service plan or a single health care
1-20 service plan.
1-21 SECTION 2. The Texas Health Maintenance Organization Act
1-22 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
1-23 Section 39 to read as follows:
1-24 Sec. 39. CREDENTIALING OF PHYSICIANS AND PROVIDERS.
1-25 (a) Rules adopted by the commissioner under Section 37 of this Act
2-1 that relate to implementation and maintenance by a health
2-2 maintenance organization of a process for selecting and retaining
2-3 affiliated physicians and providers must comply with:
2-4 (1) this section; and
2-5 (2) standards promulgated by the National Committee
2-6 for Quality Assurance, to the extent those standards do not
2-7 conflict with other laws of this state.
2-8 (b) The commissioner shall require a health maintenance
2-9 organization to verify that a physician's license to practice
2-10 medicine and any other certificate the physician is required to
2-11 hold, including a certificate issued by the Department of Public
2-12 Safety of the State of Texas or the federal Drug Enforcement Agency
2-13 or a certificate issued under the Medicare program, is valid as of
2-14 the date of initial credentialing and on the date of each
2-15 recredentialing.
2-16 (c) The commissioner shall require a health maintenance
2-17 organization that conducts a site visit for the purpose of initial
2-18 credentialing to evaluate during the visit a site's accessibility,
2-19 appearance, space, medical or dental recordkeeping practices,
2-20 availability of appointments, and confidentiality procedures. The
2-21 commissioner may not require the health maintenance organization to
2-22 evaluate the appropriateness of equipment during the site visit.
2-23 (d) The commissioner may not require that a health
2-24 maintenance organization:
2-25 (1) formally recredential physicians or providers more
2-26 frequently than once in any three-year period;
3-1 (2) verify the validity of a license or certificate
3-2 held by a physician other than as of the date of initial
3-3 credentialing or recredentialing of the physician;
3-4 (3) use clinical personnel to perform a site visit for
3-5 initial credentialing of a physician or provider unless clinical
3-6 review is needed during the site visit; or
3-7 (4) require a site visit be performed for
3-8 recredentialing of a physician or provider.
3-9 (e) This section does not preclude a health maintenance
3-10 organization from performing a site visit of a physician or
3-11 provider at any time for cause, including a complaint made by a
3-12 member or another external complaint made to the health maintenance
3-13 organization.
3-14 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
3-15 amended by adding Article 21.58D to read as follows:
3-16 Art. 21.58D. STANDARDIZED FORM FOR VERIFICATION OF PHYSICIAN
3-17 CREDENTIALS
3-18 Sec. 1. DEFINITION. In this article, "physician" means an
3-19 individual licensed to practice medicine in this state.
3-20 Sec. 2. STANDARDIZED FORM. (a) The commissioner by rule
3-21 shall:
3-22 (1) adopt a standardized form for the verification of
3-23 the credentials of a physician; and
3-24 (2) require that a public or private hospital, a
3-25 health maintenance organization operating under the Texas Health
3-26 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-1 Code), or a preferred provider organization operating under Article
4-2 3.70-3C, Insurance Code, as added by Chapter 1024, Acts of the 75th
4-3 Legislature, Regular Session, 1997, use the form for verification
4-4 of credentials.
4-5 (b) In adopting a form under Subsection (a) of this section,
4-6 the commissioner shall consider any credentialing application form
4-7 that is widely used in this state.
4-8 SECTION 4. (a) The Texas State Board of Medical Examiners
4-9 shall study the establishment of a program for standardized
4-10 credentials verification through using a credentialing information
4-11 system.
4-12 (b) Not later than January 1, 2003, the Texas State Board of
4-13 Medical Examiners shall report on its recommendations for proposed
4-14 legislation, based on the study conducted under Subsection (a) of
4-15 this section, to:
4-16 (1) the governor;
4-17 (2) the lieutenant governor; and
4-18 (3) the speaker of the house of representatives.
4-19 SECTION 5. Sections 2, 3, and 4 of this Act take effect
4-20 September 1, 2001. Section 1 of this Act takes effect September 1,
4-21 2001, and applies only to an evidence of coverage that is
4-22 delivered, issued for delivery, or renewed on or after January 1,
4-23 2002. An evidence of coverage that is delivered, issued for
4-24 delivery, or renewed before January 1, 2002, is governed by the law
4-25 as it existed immediately before the effective date of this Act,
4-26 and that law is continued in effect for that purpose.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 544 passed the Senate on
April 5, 2001, by the following vote: Yeas 30, Nays 0, one present
not voting; and that the Senate concurred in House amendment on
May 26, 2001, by a viva-voce vote.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 544 passed the House, with
amendment, on May 23, 2001, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor