By: Carona S.B. No. 1143 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the selection and retention of affiliated physicians 1-3 and providers by health maintenance organizations. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. The Texas Health Maintenance Organization Act 1-6 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding 1-7 Section 39 to read as follows: 1-8 Sec. 39. CREDENTIALING OF PHYSICIANS AND PROVIDERS. 1-9 (a) Rules adopted by the commissioner under Section 37 of this Act 1-10 that relate to implementation and maintenance by a health 1-11 maintenance organization of a process for selecting and retaining 1-12 affiliated physicians and providers must comply with: 1-13 (1) this section; and 1-14 (2) standards promulgated by the National Committee 1-15 for Quality Assurance, to the extent those standards do not 1-16 conflict with other laws of this state. 1-17 (b) The commissioner shall require a health maintenance 1-18 organization to verify that a physician's license to practice 1-19 medicine and any other certificate the physician is required to 1-20 hold, including a certificate issued by the Department of Public 1-21 Safety of the State of Texas or the federal Drug Enforcement Agency 1-22 or a certificate issued under the Medicare program, is valid as of 1-23 the date of initial credentialing and on the date of each 1-24 recredentialing. 1-25 (c) The commissioner shall require a health maintenance 2-1 organization that conducts a site visit for the purpose of initial 2-2 credentialing to evaluate during the visit a site's accessibility, 2-3 appearance, space, medical or dental recordkeeping practices, 2-4 availability of appointments, and confidentiality procedures. The 2-5 commissioner may not require the health maintenance organization to 2-6 evaluate the appropriateness of equipment during the site visit. 2-7 (d) The commissioner may not require that a health 2-8 maintenance organization: 2-9 (1) formally recredential physicians or providers more 2-10 frequently than once in any three-year period; 2-11 (2) verify the validity of a license or certificate 2-12 held by a physician other than as of the date of initial 2-13 credentialing or recredentialing of the physician; 2-14 (3) use clinical personnel to perform a site visit for 2-15 initial credentialing of a physician or provider unless clinical 2-16 review is needed during the site visit; or 2-17 (4) require a site visit be performed for 2-18 recredentialing of a physician or provider. 2-19 (e) This section does not preclude a health maintenance 2-20 organization from performing a site visit of a physician or 2-21 provider at any time for cause, including a complaint made by a 2-22 member or another external complaint made to the health maintenance 2-23 organization. 2-24 SECTION 2. This Act takes effect September 1, 2001.