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A BILL TO BE ENTITLED
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AN ACT
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relating to the regulation of health organizations certified by the |
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Texas Medical Board; imposing an administrative penalty. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 162, Occupations Code, is |
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amended by adding Sections 162.0021, 162.0022, 162.0023, and |
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162.0024 to read as follows: |
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Sec. 162.0021. INTERFERENCE WITH PHYSICIAN'S PROFESSIONAL |
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JUDGMENT PROHIBITED. A health organization certified under Section |
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162.001(b) may not interfere with, control, or otherwise direct a |
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physician's professional judgment in violation of this subchapter |
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or any other provision of law, including board rules. |
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Sec. 162.0022. HEALTH ORGANIZATION POLICIES. (a) A health |
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organization certified under Section 162.001(b) shall adopt, |
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maintain, and enforce policies to ensure that a physician employed |
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by the health organization exercises independent medical judgment |
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when providing care to patients. |
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(b) The policies adopted under this section must include |
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policies relating to: |
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(1) credentialing; |
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(2) quality assurance; |
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(3) utilization review; and |
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(4) peer review. |
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(c) The policies adopted under this section, including any |
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amendments to the policies, must be developed by the board of |
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directors or board of trustees, as applicable, of the health |
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organization and approved by an affirmative vote. |
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(d) The policies of the health organization must be drafted |
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and interpreted in a manner that reserves the sole authority to |
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engage in the practice of medicine to a physician participating in |
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the health organization, regardless of the physician's employment |
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status with the health organization. |
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Sec. 162.0023. DISCIPLINARY ACTION RESTRICTION. A |
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physician employed by a health organization certified under Section |
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162.001(b) retains independent medical judgment in providing care |
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to patients, and the health organization may not discipline the |
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physician for reasonably advocating for patient care. |
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Sec. 162.0024. CONTRACTUAL WAIVER PROHIBITED. (a) The |
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requirements of this subchapter may not be voided or waived by |
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contract. |
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(b) Notwithstanding Subsection (a), a member of a health |
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organization certified under Section 162.001(b) may establish |
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ethical and religious directives and a physician may contractually |
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agree to comply with those directives. |
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SECTION 2. Section 162.003, Occupations Code, is amended to |
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read as follows: |
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Sec. 162.003. REFUSAL TO CERTIFY; REVOCATION; PENALTY. On |
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a determination that a health organization is established, |
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organized, or operated in violation of or with the intent to violate |
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this subtitle, the board may: |
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(1) [may] refuse to certify the health organization on |
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application for certification by the organization under Section |
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162.001; [and] |
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(2) [shall] revoke a certification made under Section |
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162.001 to that organization; or |
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(3) impose an administrative penalty against the |
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health organization under Subchapter A, Chapter 165. |
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SECTION 3. (a) Except as provided by Subsection (b) of |
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this section, this Act takes effect September 1, 2011. |
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(b) Section 162.0022, Occupations Code, as added by this |
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Act, takes effect January 1, 2012. |