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A BILL TO BE ENTITLED
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AN ACT
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relating to the establishment of an advisory committee to develop a |
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process for the collection of information necessary to facilitate |
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physician credentialing by Medicaid managed care organizations. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0975 to read as follows: |
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Sec. 531.0975. ADVISORY COMMITTEE ON PHYSICIAN |
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CREDENTIALING BY MEDICAID MANAGED CARE ORGANIZATIONS. (a) The |
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executive commissioner shall establish an advisory committee to |
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assist the commission in developing and maintaining a process for |
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the collection of information from physicians to facilitate the |
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performance of the credentialing and recredentialing processes by |
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Medicaid managed care organizations. |
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(b) The advisory committee shall be composed of nine members |
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appointed by the executive commissioner as follows: |
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(1) four members who are physicians; |
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(2) four members who are representatives of managed |
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care organizations; and |
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(3) one member who is a representative of the |
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commission. |
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(c) In order to be eligible for appointment to the advisory |
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committee under Subsection (b), a person must be knowledgeable |
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about national standards relating to the credentialing process for |
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physicians. |
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(d) The executive commissioner shall designate one advisory |
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committee member to serve as presiding officer. |
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(e) The advisory committee shall develop and the executive |
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commissioner shall adopt rules for the establishment of a process |
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through which the commission collects from a physician seeking to |
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be included in or remain in the provider network of a Medicaid |
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managed care organization all of the necessary information for the |
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organization to perform a sufficient credentialing or |
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recredentialing process to determine if the physician is qualified |
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to be included in or remain in the organization's provider network. |
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The rules must include the content and format of the form that a |
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physician must use to submit information to the commission for |
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purposes of the credentialing or recredentialing process. |
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(f) The advisory committee shall meet at least once each |
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calendar year at the call of the presiding officer to review the |
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information that the commission collects and to determine if that |
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information is sufficient to enable a Medicaid managed care |
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organization to perform credentialing and recredentialing |
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processes for physicians that comply with federal and state law and |
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standards developed by relevant national accreditation |
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organizations. The advisory committee shall submit to the executive |
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commissioner recommendations for any necessary changes to |
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commission rules as a result of this review. |
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(g) Nothing in this section shall be construed to: |
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(1) prohibit a Medicaid managed care organization from |
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requesting additional information from a physician for the purposes |
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of the credentialing or recredentialing process; or |
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(2) require a Medicaid managed care organization to |
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include in the organization's provider network a physician who |
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submits information to the commission as part of the process |
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established under this section. |
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(h) The advisory committee members shall serve staggered |
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three-year terms. |
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(i) An advisory committee member who no longer meets the |
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qualifications for service on the advisory committee must resign |
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from the advisory committee. |
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(j) The executive commissioner shall fill a vacancy on the |
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advisory committee in the same manner as other appointments to the |
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advisory committee. |
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(k) An advisory committee member may not receive |
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compensation for serving on the advisory committee and may not be |
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reimbursed for expenses incurred while conducting the business of |
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the advisory committee. |
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(l) The commission shall provide administrative support to |
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the advisory committee. |
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(m) Chapter 2110 does not apply to the advisory committee. |
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SECTION 2. (a) Not later than October 1, 2015, the |
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executive commissioner of the Health and Human Services Commission |
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shall establish the advisory committee and appoint the advisory |
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committee members for terms beginning September, 1, 2015, as |
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required by Section 531.0975, Government Code, as added by this |
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Act. |
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(b) In making the initial appointments and notwithstanding |
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Section 531.0975(h), Government Code, as added by this Act, the |
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executive commissioner shall designate one-third of the members to |
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serve for terms expiring August 31, 2016, one-third of the members |
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to serve for terms expiring August 31, 2017, and the remaining |
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one-third of the members to serve for terms expiring August 31, |
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2018. |
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SECTION 3. Not later than January 1, 2016, the advisory |
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committee established under Section 531.0975, Government Code, as |
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added by this Act, shall make initial recommendations and the |
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executive commissioner of the Health and Human Services Commission |
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shall adopt or amend rules as necessary in accordance with Section |
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531.0975(e), Government Code, as added by this Act. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2015. |