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.