77R13557 MXM-F
By Carona S.B. No. 1143
Substitute the following for S.B. No. 1143:
By Seaman C.S.S.B. No. 1143
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the credentialing of physicians and health care
1-3 providers.
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. (a)
1-9 Rules adopted by the commissioner under Section 37 of this Act that
1-10 relate to implementation and maintenance by a health maintenance
1-11 organization of a process for selecting and retaining affiliated
1-12 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.
2-1 (c) The commissioner shall require a health maintenance
2-2 organization that conducts a site visit for the purpose of initial
2-3 credentialing to evaluate during the visit a site's accessibility,
2-4 appearance, space, medical or dental recordkeeping practices,
2-5 availability of appointments, and confidentiality procedures. The
2-6 commissioner may not require the health maintenance organization to
2-7 evaluate the appropriateness of equipment during the site visit.
2-8 (d) The commissioner may not require that a health
2-9 maintenance organization:
2-10 (1) formally recredential physicians or providers more
2-11 frequently than once in any three-year period;
2-12 (2) verify the validity of a license or certificate
2-13 held by a physician other than as of the date of initial
2-14 credentialing or recredentialing of the physician;
2-15 (3) use clinical personnel to perform a site visit for
2-16 initial credentialing of a physician or provider unless clinical
2-17 review is needed during the site visit; or
2-18 (4) require a site visit be performed for
2-19 recredentialing of a physician or provider.
2-20 (e) This section does not preclude a health maintenance
2-21 organization from performing a site visit of a physician or
2-22 provider at any time for cause, including a complaint made by a
2-23 member or another external complaint made to the health maintenance
2-24 organization.
2-25 SECTION 2. Subchapter E, Chapter 21, Insurance Code, is
2-26 amended by adding Article 21.58D to read as follows:
2-27 Art. 21.58D. STANDARDIZED FORM FOR VERIFICATION OF PHYSICIAN
3-1 CREDENTIALS
3-2 Sec. 1. DEFINITION. In this article, "physician" means an
3-3 individual licensed to practice medicine in this state.
3-4 Sec. 2. STANDARDIZED FORM. (a) The commissioner by rule
3-5 shall:
3-6 (1) adopt a standardized form for the verification of
3-7 the credentials of a physician; and
3-8 (2) require that a public or private hospital, a
3-9 health maintenance organization operating under the Texas Health
3-10 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
3-11 Code), or a preferred provider organization operating under Article
3-12 3.70-3C, Insurance Code, as added by Chapter 1024, Acts of the 75th
3-13 Legislature, Regular Session, 1997, use the form for verification
3-14 of credentials.
3-15 (b) In adopting a form under Subsection (a) of this section,
3-16 the commissioner shall consider any credentialing application form
3-17 that is widely used in this state.
3-18 SECTION 3. (a) The Texas State Board of Medical Examiners
3-19 shall study the establishment of a program for standardized
3-20 credentials verification through using a credentialing information
3-21 system.
3-22 (b) Not later than January 1, 2003, the Texas State Board of
3-23 Medical Examiners shall report on its recommendations for proposed
3-24 legislation, based on the study conducted under Subsection (a) of
3-25 this section, to:
3-26 (1) the governor;
3-27 (2) the lieutenant governor; and
4-1 (3) the speaker of the house of representatives.
4-2 SECTION 4. This Act takes effect September 1, 2001.