1-1 By: Carona S.B. No. 1143 1-2 (In the Senate - Filed March 6, 2001; March 7, 2001, read 1-3 first time and referred to Committee on Business and Commerce; 1-4 March 29, 2001, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 7, Nays 0; March 29, 2001, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1143 By: Carona 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to the selection and retention of affiliated physicians 1-11 and providers by health maintenance organizations. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. The Texas Health Maintenance Organization Act 1-14 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding 1-15 Section 39 to read as follows: 1-16 Sec. 39. CREDENTIALING OF PHYSICIANS AND PROVIDERS. 1-17 (a) Rules adopted by the commissioner under Section 37 of this Act 1-18 that relate to implementation and maintenance by a health 1-19 maintenance organization of a process for selecting and retaining 1-20 affiliated physicians and providers must comply with: 1-21 (1) this section; and 1-22 (2) standards promulgated by the National Committee 1-23 for Quality Assurance, to the extent those standards do not 1-24 conflict with other laws of this state. 1-25 (b) The commissioner shall require a health maintenance 1-26 organization to verify that a physician's license to practice 1-27 medicine and any other certificate the physician is required to 1-28 hold, including a certificate issued by the Department of Public 1-29 Safety of the State of Texas or the federal Drug Enforcement Agency 1-30 or a certificate issued under the Medicare program, is valid as of 1-31 the date of initial credentialing and on the date of each 1-32 recredentialing. 1-33 (c) The commissioner shall require a health maintenance 1-34 organization that conducts a site visit for the purpose of initial 1-35 credentialing to evaluate during the visit a site's accessibility, 1-36 appearance, space, medical or dental recordkeeping practices, 1-37 availability of appointments, and confidentiality procedures. The 1-38 commissioner may not require the health maintenance organization to 1-39 evaluate the appropriateness of equipment during the site visit. 1-40 (d) The commissioner may not require that a health 1-41 maintenance organization: 1-42 (1) formally recredential physicians or providers more 1-43 frequently than once in any three-year period; 1-44 (2) verify the validity of a license or certificate 1-45 held by a physician other than as of the date of initial 1-46 credentialing or recredentialing of the physician; 1-47 (3) use clinical personnel to perform a site visit for 1-48 initial credentialing of a physician or provider unless clinical 1-49 review is needed during the site visit; or 1-50 (4) require a site visit be performed for 1-51 recredentialing of a physician or provider. 1-52 (e) This section does not preclude a health maintenance 1-53 organization from performing a site visit of a physician or 1-54 provider at any time for cause, including a complaint made by a 1-55 member or another external complaint made to the health maintenance 1-56 organization. 1-57 SECTION 2. This Act takes effect September 1, 2001. 1-58 * * * * *