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78R5863 JMM-D


By:  Nelson, et al.                                               S.B. No. 104

Substitute the following for S.B. No. 104:                                    

By:  Laubenberg                                               C.S.S.B. No. 104


A BILL TO BE ENTITLED
AN ACT
relating to the regulation and enforcement of the practice of medicine by the Texas State Board of Medical Examiners. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 153.051(d), Occupations Code, is amended to read as follows: (d) The board may not set, charge, collect, receive, or deposit any of the following fees in excess of: (1) $900 for a license; (2) $400 [$200] for a first [annual] registration permit; (3) $200 for a temporary license; (4) $400 [$200] for renewal of a [an annual] registration permit; (5) $200 for a physician-in-training permit; (6) $600 [$300] for the processing of an application and the issuance of a [an annual] registration for anesthesia in an outpatient setting; (7) $200 for an endorsement to other state medical boards; (8) $200 for a duplicate license; or (9) $700 for a reinstated license after cancellation for cause. SECTION 2. Section 153.053, Occupations Code, is amended to read as follows: Sec. 153.053. SURCHARGE FOR CERTAIN FEES. (a) The board shall collect a fee [an additional $200] surcharge as follows [for each of the following fees]: (1) $200 for the license fee; (2) $400 for the first [annual] registration permit; (3) $400 for renewal of a [annual] registration permit; and (4) $200 for reinstatement of a license after cancellation for cause. (b) Of each surcharge collected under Subsections (a)(1) and (4), the board shall deposit $50 to the credit of the foundation school fund and $150 to the credit of the general revenue fund. (c) Of each surcharge collected under Subsections (a)(2) and (3), the board shall deposit $100 to the credit of the foundation school fund and $150 to the credit of the general revenue fund. SECTION 3. Subchapter B, Chapter 153, Occupations Code, is amended by adding Section 153.0535 to read as follows: Sec. 153.0535. SURCHARGE FOR REGISTRATION PERMIT. (a) The board shall collect an additional $30 surcharge for each of the following fees: (1) first registration permit; and (2) renewal of a registration permit. (b) The board shall deposit each surcharge collected to the credit of the public assurance account. The public assurance account is an account in the general revenue fund that shall be appropriated only to the board to pay for the board's enforcement program, including the expert physician panel. SECTION 4. Section 154.056, Occupations Code, is amended by amending Subsection (a) and adding Subsection (e) to read as follows: (a) The board shall adopt rules concerning the investigation and review of a complaint filed with the board. The rules adopted under this section must: (1) distinguish among categories of complaints and give priority to complaints that involve sexual misconduct, quality of care, and impaired physician issues; (2) ensure that a complaint is not dismissed without appropriate consideration; (3) require that the board be advised of the dismissal of a complaint and that a letter be sent to the person who filed the complaint and to the physician who was the subject of the complaint explaining the action taken on the complaint; (4) ensure that a person who files a complaint has an opportunity to explain the allegations made in the complaint; [and] (5) prescribe guidelines concerning the categories of complaints that require the use of a private investigator and the procedures for the board to obtain the services of a private investigator; and (6) provide for an expert physician panel authorized under Subsection (e) to assist with complaints and investigations relating to medical competency. (e) The board by rule shall provide for an expert physician panel appointed by the board to assist with complaints and investigations relating to medical competency. Each member of an expert physician panel must be licensed to practice medicine in this state. The rules adopted under this subsection must include provisions governing the composition of the panel, qualifications for membership on the panel, and the duties to be performed by the panel. SECTION 5. Section 154.058, Occupations Code, is amended to read as follows: Sec. 154.058. DETERMINATION OF MEDICAL COMPETENCY. (a) Each complaint against a physician that requires a determination of medical competency shall be reviewed initially by a board member, consultant, or employee with a medical background considered sufficient by the board. (b) If the initial review under Subsection (a) indicates that an act by a physician falls below an acceptable standard of care, the complaint shall be reviewed by an expert physician panel authorized under Section 154.056(e) consisting of physicians who practice in the same specialty as the physician who is the subject of the complaint or in another specialty that is similar to the physician's specialty. (c) The expert physician panel shall report in writing the panel's determinations based on the review of the complaint under Subsection (b). The report must specify the standard of care that applies to the facts that are the basis of the complaint and the clinical basis for the panel's determinations, including any reliance on peer-reviewed journals, studies, or reports. SECTION 6. The heading to Chapter 156, Occupations Code, is amended to read as follows:
CHAPTER 156. REGISTRATION OF PHYSICIANS [LICENSE RENEWAL]
SECTION 7. Section 156.001, Occupations Code, is amended to read as follows: Sec. 156.001. [ANNUAL] REGISTRATION REQUIREMENTS AND PROCEDURES [REQUIRED; REGISTRATION PROCEDURE]. (a) Each person licensed to practice medicine in this state must register with the board every two years [annually]. The initial [annual] registration permit shall be issued with the license and expires on the first day of the birth month of the license holder. (b) Except as provided by Section 156.002, the application for registration must be accompanied by a [an annual] registration permit fee in an amount set by the board regardless of whether the person is practicing medicine in this state. (c) A license holder may renew the [annual] registration permit by submitting to the board, on or before the expiration date of the [annual] registration permit, the required renewal application and registration renewal fee. Each [annual] registration permit renewal application must include: (1) the license holder's name, [and] mailing address, and address for receipt of electronic mail; (2) the primary place [or places] at which the license holder is engaged in the practice of medicine; and (3) other necessary information as prescribed by [the] board rule. (d) If the license holder [person] is licensed to practice medicine by another state or country or by the uniformed services of the United States, the registration renewal application must include a description of any investigation the license holder [person] knows is in progress and any sanction imposed by or disciplinary matter pending in the state, country, or service regarding the license holder [person]. SECTION 8. Section 156.002, Occupations Code, is amended to read as follows: Sec. 156.002. EXEMPTION FOR CERTAIN PHYSICIANS. (a) The board by rule may exempt a retired physician from the [annual] registration permit fee requirement. (b) A physician licensed by the board whose only practice is voluntary charity care, as defined by board rule, is exempt from the [annual] registration permit fee requirement. SECTION 9. Section 156.003, Occupations Code, is amended to read as follows: Sec. 156.003. STAGGERED RENEWAL SYSTEM. (a) The board by rule may adopt a system under which [annual] registration permits expire on various dates during the two-year registration period [year]. (b) For the registration period [year] in which the expiration date is changed, [annual] registration permit fees shall be prorated. On renewal of the registration on the new expiration date, the total [annual] registration permit fee is payable. SECTION 10. Section 156.004, Occupations Code, is amended to read as follows: Sec. 156.004. NOTICE OF EXPIRATION. The board shall send a [mail an annual] registration permit renewal application notice to each physician at the physician's last known address according to the board's records at least 30 days before the expiration date of the [annual] registration permit. The board shall provide for a 30-day grace period for renewing the [annual] registration permit from the date of the expiration of the permit. SECTION 11. Section 156.005, Occupations Code, is amended to read as follows: Sec. 156.005. RENEWAL OF CERTAIN REGISTRATION PERMITS. (a) If a person's [annual] registration permit has been expired for 90 days or less, the person may renew the permit by submitting to the board the required registration renewal application, the registration renewal fee, and a $75 [$50] penalty fee. (b) If the person's [annual] registration permit has been expired for longer than 90 days but less than one year, the person may renew the permit by submitting to the board the required registration renewal application, the registration renewal fee, and a $150 [$100] penalty fee. (c) If the person's [annual] registration permit has been expired for one year or longer, the person's license is automatically [considered to have been] canceled, unless an investigation is pending, and the person may not renew the [annual] registration permit. (d) A physician whose license is automatically [considered] canceled may obtain a new license by [submitting to reexamination and] complying with the requirements, fees, and procedures for obtaining a new license. The board may issue a new license without examination to a person whose license is automatically [considered] canceled for less than two years. SECTION 12. Section 156.007, Occupations Code, is amended to read as follows: Sec. 156.007. ISSUANCE OF [ANNUAL] REGISTRATION PERMIT. (a) On receipt of a registration renewal application and all required fees, the board, after ascertaining from the records of the board or from other sources considered reliable by the board that the applicant is an eligible [a] physician in this state and meets all other requirements for registration, shall issue to the applicant a [an annual] registration permit certifying that the applicant has filed the application, has paid the [annual] registration permit fee for the registration period [year], and has completed the requirements for [annual] registration. (b) The filing of the registration renewal application, the payment of the required fees, and the issuance of the permit do [does] not entitle the permit holder to practice medicine in this state unless: (1) the permit holder has been previously licensed as a physician by the board, as prescribed by law; [and] (2) the license to practice medicine is in effect; (3) the permit holder has met the continuing medical education requirements; and (4) the permit holder has submitted a current complete physician profile. SECTION 13. Section 156.008, Occupations Code, is amended to read as follows: Sec. 156.008. PRACTICING MEDICINE WITHOUT [ANNUAL] REGISTRATION PROHIBITED. (a) Practicing medicine after the expiration of the 30-day grace period under Section 156.004 following expiration of a [an annual] registration permit that has not been renewed for the current registration period [year] as provided by this subchapter has the same effect as, and is subject to all penalties of, practicing medicine without a license. (b) In a prosecution for the unlawful practice of medicine, the receipt showing payment of the [annual] registration fee required by this chapter does not constitute evidence that the receipt holder is lawfully entitled to practice medicine. SECTION 14. Section 156.009, Occupations Code, is amended to read as follows: Sec. 156.009. INACTIVE STATUS. The board may adopt rules and set reasonable fees relating to placing license holders on inactive status. [The board by rule shall set a time limit for the period during which a license holder may remain on inactive status.] SECTION 15. Sections 156.051(a) and (d), Occupations Code, are amended to read as follows: (a) The board by rule shall adopt, monitor, and enforce a reporting program for the continuing medical education of license holders. The board shall adopt and administer rules that: (1) establish the number of hours of continuing medical education the board determines appropriate as a prerequisite to the [annual] registration of a license under this subtitle; (2) require at least one-half of the hours of continuing medical education established under Subdivision (1) to be board approved; and (3) adopt a process to assess a license holder's participation in continuing medical education courses. (d) This section does not apply to a license holder who is [retired and is] exempt by rule from paying the [annual] registration fee under Section 156.002(a). SECTION 16. Section 156.052, Occupations Code, is amended to read as follows: Sec. 156.052. PRESUMPTION OF COMPLIANCE FOR CERTAIN LICENSE HOLDERS. A license holder is presumed to be in compliance with the requirements of this subchapter if, during the 36 months preceding the date of the required [annual] registration, the license holder becomes board certified or recertified by [in] a [medical] specialty board approved by [and that medical specialty program considers the standards of: [(1)] the American Board of Medical Specialties[; [(2) the American Medical Association; [(3) the Advisory Board for Osteopathic Specialists and Boards of Certification;] or [(4)] the American Osteopathic Association Bureau of Osteopathic Specialists. SECTION 17. Section 156.053, Occupations Code, is amended to read as follows: Sec. 156.053. TEMPORARY EXEMPTION. (a) The board may temporarily exempt a license holder from the continuing medical education requirement on the basis of [for]: (1) catastrophic illness; (2) military service outside this state for longer than one year; (3) medical practice and residence outside the United States for longer than one year; or (4) good cause shown on the written application of the license holder that provides evidence satisfactory to the board that the license holder is unable to comply with the requirement. (b) A temporary exemption granted under Subsection (a) may not exceed one year but may be renewed [annually]. SECTION 18. Section 162.104(a), Occupations Code, is amended to read as follows: (a) The board shall require each physician who administers anesthesia or performs a surgical procedure for which anesthesia services are provided in an outpatient setting to [annually] register with the board on a form prescribed by the board and to pay a fee to the board in an amount established by the board. SECTION 19. Section 164.001, Occupations Code, is amended by adding Subsection (f) to read as follows: (f) The board by rule shall adopt a schedule of the disciplinary sanctions that the board may impose under this subchapter. In adopting the schedule of sanctions, the board shall ensure that the severity of the sanction imposed is appropriate to the type of violation or conduct that is the basis for disciplinary action. SECTION 20. Section 164.003, Occupations Code, is amended by amending Subsections (b) and (c) and adding Subsections (e) and (f) to read as follows: (b) Rules adopted under this section must require that: (1) an informal meeting in compliance with Section 2001.054, Government Code, be scheduled not later than the 180th day after the date the complaint is filed with the board under Section 154.051, unless good cause is shown by the board for scheduling the informal meeting after that date; (2) the board give notice to the license holder of the time and place of the meeting not later than the 30th day before the date the meeting is held; (3) the complainant and the license holder be provided an opportunity to be heard; (4) [(2)] the board's legal counsel or a representative of the attorney general be present to advise the board or the board's staff; and (5) [(3)] a member of the board's staff at the meeting present to the board's representative the facts the staff reasonably believes it could prove by competent evidence or qualified witnesses at a hearing. (c) An affected physician is entitled to: (1) reply to the staff's presentation; [and] (2) present the facts the physician reasonably believes the physician could prove by competent evidence or qualified witnesses at a hearing; (3) be present in person or through an attorney at the entire meeting with the board's representative, except for deliberations as to the disposition of the complaint; (4) receive, with the required notice of the meeting, a complete copy of any exculpatory evidence, reports, or information in the possession or control of the board or the board's staff; (5) receive, at least 10 days before the date of the meeting, a complete copy of any information, including reports, summaries, and clinical records provided to the board's representative by the board's staff; and (6) if applicable, a statement and explanation of the standard of care the physician is alleged to have violated, including any reports of an expert physician panel and clinical peer-reviewed information used by the board to establish the existence of the alleged violation. (e) For purposes of Subsections (c)(4), (5), and (6), the information provided by the board to the physician must include the facts of the case as known to the board and any expert physician panel report. The board is not required under those subdivisions to provide the following information: (1) a board investigative report or memorandum, unless the report or memorandum contains exculpatory evidence or information; (2) the identity of a nontestifying complainant; or (3) attorney-client communications, attorney work product, or other materials covered by a privilege recognized by the Texas Rules of Civil Procedure or the Texas Rules of Evidence. (f) If the license holder has previously been the subject of disciplinary action by the board, the board shall schedule the informal meeting as soon as practicable but not later than the deadline prescribed by Subsection (b)(1). SECTION 21. Subchapter A, Chapter 164, Occupations Code, is amended by adding Section 164.0035 to read as follows: Sec. 164.0035. DISMISSAL OF BASELESS COMPLAINT. If, during the 180-day period prescribed by Section 164.003(b)(1), the board determines that the complaint is a baseless or unfounded complaint, the board shall dismiss the complaint and include a statement in the records of the complaint that the reason for the dismissal is because the complaint was baseless or unfounded. SECTION 22. Section 164.004, Occupations Code, is amended by amending Subsection (a) and adding Subsection (c) to read as follows: (a) Except in the case of a suspension under Section 164.059 or under the terms of an agreement between the board and a license holder, a revocation, suspension, involuntary modification, or other disciplinary action relating to a license is not effective unless, before board proceedings are instituted: (1) the board gives notice, in a manner consistent with the notice requirements under Section 154.053, to the affected license holder of the facts or conduct alleged to warrant the intended action, including, if appropriate, a statement and explanation of the standard of care allegedly violated by the license holder; [and] (2) the license holder is provided with any exculpatory evidence, reports, or information in the possession or control of the board; and (3) the license holder is given an opportunity to show compliance with all requirements of law for the retention of the license, at the license holder's option, either in writing or through personal appearance at an informal meeting with one or more representatives of the board. (c) For purposes of Subsection (a), the information provided by the board to the physician must include the facts of the case as known to the board and any expert physician panel report. The board is not required under that subsection to provide the following information: (1) a board investigative report or memorandum, unless the report or memorandum contains exculpatory evidence or information; (2) the identity of a nontestifying complainant; or (3) attorney-client communications, attorney work product, or other materials covered by a privilege recognized by the Texas Rules of Civil Procedure or the Texas Rules of Evidence. SECTION 23. Section 164.010, Occupations Code, is amended by adding Subsection (c) to read as follows: (c) The board shall immediately investigate: (1) a violation of a disciplinary order by a license holder described by Subsection (a); or (2) a complaint filed against a license holder described by Subsection (a). SECTION 24. Section 164.011(c), Occupations Code, is amended to read as follows: (c) A stay or injunction may not be granted if the license holder's continued practice presents a danger to the public. A stay or injunction may not be granted for a term that exceeds 120 days. SECTION 25. Section 164.051, Occupations Code, is amended by amending Subsections (a) and (c) and adding Subsection (d) to read as follows: (a) The board may refuse to admit a person to its examination or refuse to issue a license to practice medicine and may take disciplinary action against a person if the person: (1) commits an act prohibited under Section 164.052; (2) is convicted of, or is placed on deferred adjudication community supervision or deferred disposition for: (A) a felony; or (B) a misdemeanor involving moral turpitude; (3) commits or attempts to commit a direct or indirect violation of a rule adopted under this subtitle, either as a principal, accessory, or accomplice; (4) is unable to practice medicine with reasonable skill and safety to patients because of: (A) illness; (B) drunkenness; (C) excessive use of drugs, narcotics, chemicals, or another substance; or (D) a mental or physical condition; (5) is found by a court judgment to be of unsound mind; (6) fails to practice medicine in an acceptable professional manner consistent with public health and welfare; (7) is removed, suspended, or is subject to disciplinary action taken by the person's peers in a local, regional, state, or national professional medical association or society, or is disciplined by a licensed hospital or medical staff of a hospital, including removal, suspension, limitation of hospital privileges, or other disciplinary action, if the board finds that the action: (A) was based on unprofessional conduct or professional incompetence that was likely to harm the public; and (B) was appropriate and reasonably supported by evidence submitted to the board; (8) is subject to repeated or recurring meritorious health care liability claims that in the board's opinion evidence professional incompetence likely to injure the public; or (9) except as provided by Subsection (d), holds a license to practice medicine subject to disciplinary action by another state, or subject to disciplinary action by the uniformed services of the United States, based on acts by the person that are prohibited under Section 164.052 or are similar to acts described by this subsection. (c) A certified copy of the record of another state that takes action described by Subsection (a)(9) or (d) is conclusive evidence of that action. (d) The board shall revoke a license issued under this subtitle if the license holder held a license to practice medicine in another state that has been revoked by the licensing authority in that state. SECTION 26. Section 164.053(a), Occupations Code, is amended to read as follows: (a) For purposes of Section 164.052(a)(5), unprofessional or dishonorable conduct likely to deceive or defraud the public includes conduct in which a physician: (1) commits an act that violates any [the laws of this] state or federal law if the act is connected with the physician's practice of medicine; (2) fails to keep complete and accurate records of purchases and disposals of: (A) drugs listed in Chapter 481, Health and Safety Code; or (B) controlled substances scheduled in the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.); (3) writes prescriptions for or dispenses to a person who: (A) is known to be an abuser of narcotic drugs, controlled substances, or dangerous drugs; or (B) the physician should have known was an abuser of narcotic drugs, controlled substances, or dangerous drugs; (4) writes false or fictitious prescriptions for: (A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.); (5) prescribes or administers a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed; (6) prescribes, administers, or dispenses in a manner inconsistent with public health and welfare: (A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.); (7) violates Section 311.0025, Health and Safety Code; (8) fails to supervise adequately the activities of those acting under the supervision of the physician; or (9) delegates professional medical responsibility or acts to a person if the delegating physician knows or has reason to know that the person is not qualified by training, experience, or licensure to perform the responsibility or acts. SECTION 27. Section 164.057, Occupations Code, is amended to read as follows: Sec. 164.057. REQUIRED SUSPENSION OR REVOCATION OF LICENSE FOR CERTAIN [FELONY] OFFENSES. (a) The board shall suspend a physician's license on proof that the physician has been: (1) initially convicted of: (A) a felony; or (B) a misdemeanor under Chapter 22, Penal Code, other than a misdemeanor punishable by fine only; or (2) subject to an initial finding by the trier of fact of guilt of a felony under: (A) [(1)] Chapter 481 or 483, Health and Safety Code; (B) [(2)] Section 485.033, Health and Safety Code; or (C) [(3)] the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.). (b) On final conviction for an offense [a felony] described by Subsection (a), the board shall revoke the physician's license. SECTION 28. Section 164.059, Occupations Code, is amended to read as follows: Sec. 164.059. TEMPORARY SUSPENSION OR RESTRICTION OF LICENSE. (a) The president of the board[, with board approval,] shall appoint a three-member disciplinary panel consisting of board members to determine whether a person's license to practice medicine should be temporarily suspended or restricted. (b) If the disciplinary panel determines from the evidence [or information] presented to the panel that a person licensed to practice medicine would, by the person's continuation in unrestricted practice, constitute a real danger to the health or safety of the person's patients [continuing threat to the public welfare], the disciplinary panel shall temporarily suspend or restrict the license of that person. (c) A license may be suspended or restricted by a disciplinary panel under this section without notice or hearing [on the complaint] if: (1) the board immediately provides notice of the suspension or restriction to the license holder; (2) [institution of proceedings for] a hearing on the temporary suspension or restriction before a disciplinary panel of the board is scheduled for a date not sooner than the 14th day after the date of the notice of [initiated simultaneously with] the temporary suspension or restriction; and (3) the license holder receives at least 10 days' notice before the date of the hearing on the suspension or restriction [(2) a hearing is held under Chapter 2001, Government Code, and this subtitle as soon as possible]. (d) Notwithstanding Chapter 551, Government Code, the disciplinary panel may hold a meeting by telephone conference call if immediate action is required and convening of the panel at one location is inconvenient for any member of the disciplinary panel. (e) After the hearing before the disciplinary panel described by Subsection (c), if the disciplinary panel affirms the temporary suspension or restriction of the license holder's license, the board shall schedule an informal compliance meeting that meets the requirements of Section 2001.054(c), Government Code, and Section 164.004 of this code to be held as soon as practicable, unless the license holder waives the informal meeting or an informal meeting has already been held with regard to the issues that are the basis for the temporary suspension or restriction. (f) If the license holder is unable to show compliance at the informal meeting described by Subsection (e) regarding the the informal meeting described by Subsection (e) regarding the issues that are the basis for the temporary suspension or restriction, a board representative shall file a formal complaint under Section 164.005 as soon as practicable. (g) If, after the hearing described by Subsection (c), the disciplinary panel does not temporarily suspend or restrict the license holder's license, the facts that were the basis for the temporary suspension or restriction may not be the sole basis of another proceeding to temporarily suspend or restrict the license holder's license. The board may use those same facts in a subsequent investigation to obtain new information that may be the basis for the temporary suspension or restriction of the license holder's license. For purposes of this subsection, facts that are the basis for the temporary suspension or restriction of a license holder's license include facts presented to the disciplinary panel and facts known to the board or a representative of the board at the time evidence was presented to the disciplinary panel. SECTION 29. Section 164.060(c), Occupations Code, is amended to read as follows: (c) If the board, during its review of a complaint against a physician, discovers an act or omission that may constitute a felony, a misdemeanor involving moral turpitude, a violation of state or federal narcotics or controlled substance laws, [or] an offense involving fraud or abuse under the Medicare or Medicaid programs, or a violation of the workers' compensation laws under Subtitle A, Title 5, Labor Code, the board shall immediately report that act or omission to the appropriate prosecuting authority. SECTION 30. (a) This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2003. (b) The Texas State Board of Medical Examiners shall adopt rules required by Section 164.001(f), Occupations Code, as added by this Act, not later than January 1, 2004. (c) The change in law made by this Act by the amendment of Section 164.051, Occupations Code, applies to a physician whose license to practice medicine in another state was revoked on, before, or after the effective date of this Act. (d) The change in law made by this Act by the amendment of Section 164.057, Occupations Code, applies only to a person who is initially convicted of an offense on or after the effective date of this Act. A person initially convicted of an offense before that date is governed by the law in effect on the date the conviction occurred, and the former law is continued in effect for that purpose. SECTION 31. (a) The changes in law made by this Act relating to the biennial registration of physicians apply to a person who files with the Texas State Board of Medical Examiners an application for registration under Chapter 156, Occupations Code, as amended by this Act, on or after January 1, 2004. A person who files an application before that date is governed by the law in effect on the date the application was filed, and the former law is continued in effect for that purpose. (b) The Texas State Board of Medical Examiners may adopt a staggered registration system as provided by Section 156.003, Occupations Code, as amended by this Act, on or after September 1, 2004. (c) The Texas State Board of Medical Examiners shall adopt the rules required by Chapter 156, Occupations Code, as amended by this Act, not later than December 1, 2003. SECTION 32. The change in law made by this Act by the enactment of Section 153.0535, Occupations Code, applies to a registration permit fee that becomes due on or after January 1, 2004. A registration permit fee that becomes due before that date is governed by the law in effect on the date the fee became due, and the former law is continued in effect for that purpose. SECTION 33. The change in law made by this Act relating to the investigation and disposition of a complaint and any proceeding begun as a result of a complaint investigation applies only to a complaint filed with the Texas State Board of Medical Examiners on or after the effective date of this Act. A complaint filed before the effective date of this Act is governed by the law in effect on the date the complaint was made, and the former law is continued in effect for that purpose.