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                                  * * * * *