By Carona S.B. No. 1143 77R9062 T A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the credentialing of physicians and providers by health 1-3 maintenance organizations. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Texas Health Maintenance Organization Act (Article 1-6 20A.37, Vernon's Texas Insurance Code), is amended by adding a new 1-7 section (h) as follows: 1-8 (h) In regard to a process for selection and retention of 1-9 affiliated providers implemented and performed by a health 1-10 maintenance organization in accordance with this article, the 1-11 department: 1-12 (1) Shall not require site visits for initial 1-13 credentialing to be performed by clinical personnel. 1-14 (2) Shall require a health maintenance organization to 1-15 primary verify that a physician's license to practice, and other 1-16 required certificates such as DPS, DEA and Medicare, are valid and 1-17 current at the time of initial credentialing and every 1-18 recredentialing, but shall not be required to verify validity or 1-19 currency of license or certificates during the interval between 1-20 scheduled credentialing as required by NCQA. 1-21 (3) Shall require that when a health maintenance 1-22 organization is conducting site visits, including the evaluation of 1-23 the quality of encounter notes, the health maintenance organization 1-24 will evaluate a site's accessibility, appearance, space, medical or 2-1 dental record keeping practices, availability of appointment and 2-2 confidentiality procedures but not the appropriateness of 2-3 equipment. 2-4 (4) Shall not require that site visits be performed in 2-5 the offices of high volume specialists. 2-6 (5) Shall not require that site visits be performed 2-7 for recredentialing of any physician or provider. 2-8 (6) Shall not require the health maintenance 2-9 organization to formally recredential physicians and providers more 2-10 frequently than every three years. 2-11 (7) Except as otherwise required by law, shall conform 2-12 regulations governing credentialing to standards promulgated and 2-13 periodically revised by the National Committee for Quality 2-14 Assurance. 2-15 SECTION 2. This Act takes effect September 1, 2001.