BILL ANALYSIS |
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C.S.S.B. 2397 |
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By: Nelson |
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Public Health |
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Committee Report (Substituted) |
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BACKGROUND AND PURPOSE
Currently, the Texas Medical Board licenses physicians, physician assistants, acupuncturists, and surgical assistants. Some of the professions licensed by the board are regulated in a manner that not only is inconsistent with how other state boards license and regulate licensees, but is inconsistent with how licensees are regulated by the board itself.
C.S.S.B. 2397 makes changes to statutes governing the licensing and regulation of physicians, physician assistants, acupuncturists, and surgical assistants.
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RULEMAKING AUTHORITY
It is the committee's opinion
that rulemaking authority is expressly granted to the Texas Medical
It is the committee's opinion that rulemaking authority is expressly granted to the commissioner of insurance in SECTION 1.03 of this bill.
It is the committee's opinion that rulemaking authority is expressly granted to the Texas Physician Assistant Board in SECTIONS 2.03 and 2.04 of this bill.
It is the committee's opinion that rulemaking authority is expressly granted to the Texas State Board of Acupuncture Examiners in SECTION 3.02 of this bill.
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ANALYSIS
C.S.S.B. 2397 amends the Occupations Code to prohibit the Texas Medical Board from considering or acting on a complaint involving care provided more than seven years before the date on which the complaint is filed unless the care was provided to a minor, in which case the board may not consider or act after the later of the date the minor is 21 years of age, or the seventh anniversary of the date of the care.
C.S.S.B. 2397 specifies that board notification to a physician who is the subject of a complaint must be by personal delivery or certified mail, and requires the notice to provide the physician with a copy of the complaint without redaction unless there is a risk of harm to the public or the notice would jeopardize an investigation. The bill requires the complaint to include a statement of the alleged violation in plain language. The bill authorizes the board, if a physician rejects a notice by personal delivery or certified mail, to send to the physician an additional notice of the complaint by first class mail that includes notice of the attempted delivery by personal delivery or certified mail. The bill requires the board, if it subpoenas the records of a patient in the course of an investigation, to send notice to the address available in the records to the patient or the patient's guardian unless the notice would jeopardize the investigation. The bill establishes the notice as confidential and prohibits its release to a third party.
C.S.S.B. 2397 prohibits the board from accepting anonymous complaints and requires a complaint filed with the board by an insurance agent or insurer against a physician to include the name and address of the agent or insurer filing the complaint. The bill requires the board, not later than the 15th day after the date the complaint is filed, to notify the physician who is the subject of the complaint of the name and address of the agent or insurer who filed the complaint, unless the notice would jeopardize an investigation. The bill establishes failure by an insurance agent or insurer to comply with the requirements of these provisions or rules adopted by the board relating to these provisions as grounds for the imposition of sanctions by the commissioner of the Texas Department of Insurance. The bill authorizes the commissioner of insurance to adopt rules to implement this provision and requires the board to adopt rules as necessary to implement provisions governing requirements for such complaints. The bill defines "anonymous complaint," "insurance agent," and "insurer" for the purposes of these provisions.
C.S.S.B. 2397 prohibits information received under provisions on the release of complaint information to a legislative committee from being released to any third party.
C.S.S.B. 2397 requires the board to complete a preliminary investigation of a complaint filed with the board against a physician licensed to practice medicine in Texas not later than the 60th, rather than the 30th, day after the date the complaint was received. The bill removes the requirement that the oath an applicant for a license to practice medicine in Texas must subscribe to be subscribed to in writing before an officer authorized by law to administer oaths. The bill adds a requirement that an applicant for a license to practice medicine must present proof satisfactory to the board that, as an alternative, the applicant is specialty board certified by a specialty board organization acceptable to the board. The bill adds to the proof a license applicant who is a graduate of a medical school located outside the United States and Canada must present to the board proof that that applicant has successfully completed at least two years of graduate medical training in the United States or Canada that was approved by the board and at least one year of graduate medical training outside either country that was approved for advanced standing by a specialty board organization approved by the board, as an alternative to proof the applicant has successfully completed at least three years of board-approved graduate medical training in either country. The bill removes from the proof such a license applicant must present to the board proof that the applicant is eligible for a license to practice medicine in the country in which the school is located, except for any citizenship requirements.
C.S.S.B. 2397 requires the rules adopted by the Texas Medical Board governing informal proceedings applicable to the grant, denial, or renewal of certain licenses to require that the board give notice to the license holder of the time and place of the informal meeting regarding the person's license not later than the 60th, rather than the 30th, day before the date the meeting is held. The bill requires the license holder's rebuttal to be provided to the board at least 15, rather than 5, business days before the date of the meeting in order for the information to be considered at the meeting.
C.S.S.B. 2397 requires the board, on request by a physician under review, to make a recording of the informal settlement conference proceeding, and establishes that the recording is a part of the investigative file and may not be released to a third party unless authorized under state law. The bill authorizes the board to charge a license holder a fee to cover the cost of recording the hearing.
C.S.S.B. 2397 clarifies that to be eligible for a license as a physician assistant an applicant must, in addition to meeting other qualifications, be of good professional character. The bill removes the exception to provisions making an applicant ineligible for a physician assistant license that the Texas Physician Assistant Board takes the fact that would otherwise make the applicant ineligible into consideration in determining whether to issue the license. The bill authorizes the physician assistant board to adopt rules and set fees relating to granting temporary licenses and extending the expiration dates of temporary licenses. The bill requires the physician assistant board by rule to set a time limit for the term of a temporary license. The bill removes the authorization for the physician assistant board to issue a temporary license to an applicant who fulfills certain conditions, and removes the provision that a temporary license may be valid for not more than one year after the date issued as determined by board rule.
C.S.S.B. 2397 authorizes the physician assistant board by rule to issue a physician assistant postgraduate training permit to a physician assistant not otherwise licensed by the physician assistant board who is participating in a board-approved graduate physician assistant education training program. The bill establishes that such a postgraduate training permit does not authorize the performance of a physician assistant act by the permit holder unless the act is performed as a part of the graduate medical education training program, and under the supervision of a physician and physician assistant. The bill grants the physician assistant board jurisdiction to discipline a permit holder whose permit has expired if the violation of the law occurred during the time the permit was valid and establishes that if an investigation is open when the permit expires the permit shall be executory and the board may retain jurisdiction. The bill establishes that if the person's license has been expired for one year or longer, the person's license is automatically canceled, unless an investigation is pending and the person may not renew the license. The bill authorizes a physician assistant whose license is automatically canceled to obtain a new license by complying with the requirements, fees, and procedures for obtaining a new license and authorizes the physician assistant board to issue a new license without examination to a person whose license is automatically canceled for less than two years.
C.S.S.B. 2397 authorizes the Texas State Board of Acupuncture Examiners to adopt rules and recommend to the Texas Medical Board fees relating to granting temporary licenses and extending the expiration dates of temporary licenses. The bill requires the acupuncture board by rule to set a time limit for the term of a temporary license. The bill removes the authorization that the acupuncture board may, through the executive director of the Texas Medical Board, issue a temporary license to an applicant who fulfills certain conditions, and removes a provision making the temporary license valid for 100 days after the date issued and authorizing extension of that license for another 30 days after the initial expiration date.
C.S.S.B. 2397 sets forth confidentiality provisions regarding each complaint, adverse report, investigation file, other investigation report, and other investigative information in the possession of or received or gathered by the acupuncture board or a Texas Medical Board employee or agent. The bill exempts investigation records relating to an application for license and disciplinary action of a license holder from public information provisions. The bill includes for the purposes of this provision information relating to the identity of, and a report made by, a physician performing or supervising compliance monitoring for the acupuncture board as investigative information. The bill removes the requirement that the acupuncture board prohibit or limit access to an investigation file relating to a license holder in an informal proceeding in the manner provided by state law regarding administrative hearings and confidentiality issues for physicians.
C.S.S.B. 2397 authorizes the Texas Physician Assistant Board, the Texas State Board of Acupuncture Examiners, and the Texas Medical Board to hear all evidence and arguments and conduct deliberations relating to license applications and disciplinary actions under the Physician Assistant Licensing Act, acupuncture provisions, or surgical assistant provisions, as applicable, in executive sessions. The bill requires the physician assistant board, the acupuncture board, and the Texas Medical Board to vote and announce a board decision in open session and exempts deliberations by the physician assistant board and the acupuncture board relating to license applications and disciplinary actions from open meetings general law. The bill exempts deliberations and records of the Texas Medical Board relating to the professional character and fitness of surgical assistant applicants as well as to disciplinary actions from open meeting and public information general law. The bill clarifies that to be eligible for a surgical assistant license a person must, in addition to meeting other qualifications, be of good professional character.
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EFFECTIVE DATE
September 1, 2009.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
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C.S.S.B. 2397 adds a provision not in the original providing for a complaint involving care provided more than seven years before the date on which the complaint is filed. The substitute adds provisions not in the original modifying the method of delivery and content of a notice to a physician of a complaint, specifying the procedure to be followed when a physician rejects a notice, and providing for notice in case of a subpoena of patient records by the Texas Medical Board. The substitute adds provisions not in the original establishing requirements for a complaint filed with the Texas Medical Board by an insurance agent or insurer against a physician, and providing for implementation of these provisions through rules adopted by the commissioner of insurance and by the Texas Medical Board. The substitute adds a provision not in the original prohibiting information received under provisions governing the release of complaint information to a legislative committee from being released to a third party.
C.S.S.B. 2397 differs from the original by requiring the Texas Medical Board to complete a preliminary investigation of a complaint filed with the board against a physician licensed to practice medicine in Texas not later than the 60th day, rather than the 45th day as in the original, after the date the complaint was received. The substitute differs from the original by requiring the rules adopted by the Texas Medical Board governing certain informal proceedings to require the board to give notice to the license holder of the time and place of the informal meeting regarding the person's license not later than the 60th day, rather than the 45th day as in the original, before the date the meeting is held.
C.S.S.B. 2397 adds a provision not in the original setting forth provisions for the recording of the informal settlement conference proceeding.
C.S.S.B. 2397 differs from the original by making conforming changes to the substitute's procedural provisions. |