BILL ANALYSIS |
C.S.H.B. 3040 |
By: Burkett |
Public Health |
Committee Report (Substituted) |
BACKGROUND AND PURPOSE
The Texas Medical Board, which licenses and regulates the state’s physicians as well as certain other health professions to ensure that Texans receive safe and quality medical care, is subject to the Texas Sunset Act and will be abolished on September 1, 2017, unless continued by the legislature. C.S.H.B. 3040 seeks to continue the board with several statutory modifications.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is expressly granted to the Texas Medical Board in SECTIONS 14, 16, and 18 of this bill.
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ANALYSIS
C.S.H.B. 3040 amends the Occupations Code to postpone from September 1, 2017, to September 1, 2029, the date on which the Texas Medical Board is abolished and the Medical Practice Act, the Physician Assistant Licensing Act, the Medical Radiologic Technologist Certification Act, the Medical Physics Practice Act, the Licensed Perfusionists Act, and statutory provisions relating to the practice of acupuncture and to surgical assistants expire, unless continued in existence as provided by the Texas Sunset Act. The bill revises provisions relating to the training programs for persons who are appointed to and qualify for office as a member of the medical board, the Texas Physician Assistant Board, the Texas State Board of Acupuncture Examiners, the Texas Board of Medical Radiologic Technology, or the Texas Board of Respiratory Care, as applicable, and authorizes each such board to refuse to renew an applicable permit, license, or certificate if the permit holder, license holder, or certificate holder is in violation of an board order. The bill's provisions relating to a board member training program apply to a member of the applicable board appointed before, on, or after the bill's effective date. The bill requires a board member who, before the bill's effective date, completed the training program applicable to that board as it existed before the bill's effective date to complete additional training only on the subjects added to the training program and prohibits such a board member from voting, deliberating, or being counted as a member in attendance at a meeting of the applicable board held on or after December 1, 2017, until the member completes the additional training.
C.S.H.B. 3040 authorizes the medical board, acting through the attorney general, to file suit to enforce a subpoena issued by the board in a district court in Travis County or in a county in which a hearing conducted by the board may be held if a person failed to comply with a board‑issued subpoena and requires the court, on finding that good cause exists for issuing the subpoena, to order the person to comply with the subpoena. The bill excepts the Texas medical jurisprudence examination from limitations on the number of authorized examination attempts. The bill specifies that the elements of a physician's practice that the medical board may conduct inspections of as necessary to enforce regulations on the provision of anesthesia in an outpatient setting are a physician's equipment and office procedures. The bill authorizes the medical board to establish a risk-based inspection process in which the board conducts inspections based on the length of time since the equipment and outpatient setting were last inspected and the physician submitted to inspection. The bill requires the medical board to maintain a record of the outpatient settings in which physicians provide anesthesia and requires a physician who provides anesthesia in such a setting to inform the board of any other physician with whom the physician shares equipment used to administer anesthesia.
C.S.H.B. 3040 prohibits a physician or a physician assistant from prescribing opioids, benzodiazepines, barbiturates, or carisoprodol to a patient unless the physician or physician assistant has reviewed the patient's prescription history by accessing the prescription information submitted to the Texas State Board of Pharmacy as authorized under certain provisions of the Texas Controlled Substances Act. The bill excepts a physician or physician assistant from the review requirement if the patient has been diagnosed with cancer or the patient is receiving hospice care and the physician clearly notes in the prescription record that the patient was diagnosed with cancer or is receiving hospice care, as applicable. The bill makes failure by a physician or physician assistant to comply with these duties grounds for disciplinary action. These provisions apply only to a prescription issued on or after September 1, 2018.
C.S.H.B. 3040 requires the medical board and the physician assistant board to periodically check the prescribing information submitted to the Texas State Board of Pharmacy to determine whether a licensed physician or physician assistant, as applicable, is engaging in potentially harmful prescribing patterns or practices. The bill requires the medical board and the physician assistant board, as applicable, in coordination with the board of pharmacy, to determine the conduct that constitutes a potentially harmful prescribing pattern or practice and sets out items that must be considered by the medical board and the physician assistant board, as applicable, when making that determination. The bill authorizes the medical board and the physician assistant board to notify a physician or physician assistant, as applicable, that the respective board suspects may be engaging in potentially harmful prescribing patterns or practices of the potentially harmful prescribing pattern or practice and authorizes the boards to initiate a complaint against a physician or physician assistant, as applicable, based on information obtained during the periodic monitoring.
C.S.H.B. 3040 replaces the prohibition against the medical board issuing a remedial plan to resolve a complaint against a person licensed to practice medicine if the license holder had previously entered into a remedial plan with the medical board for the resolution of a different complaint with the prohibition against the medical board issuing such a remedial plan if the license holder has entered into a remedial plan with the medical board in the preceding five years. The bill requires the rules adopted by the medical board regarding procedures governing certain informal disciplinary proceedings to require that the panel conducting an informal proceeding regarding a complaint that includes an allegation that a physician licensed under the Medical Practice Act has violated the standard of care to consider whether the physician was practicing complementary and alternative medicine. The bill requires the medical board to adopt rules necessary to implement that consideration requirement not later than March 1, 2018. The bill requires the medical board to share each report prepared by an expert physician reviewer of the complaint and to redact any identifying information of an expert physician reviewer other than the reviewer's specialty before providing to the license holder the report prepared by the reviewer as part of the complaint notice, if applicable.
C.S.H.B. 3040 revises certain provisions relating to formal complaints to remove the requirement that a charge against a person licensed under the Medical Practice Act be in the form of a written affidavit and removes language limiting the written statements deemed formal complaints with regard to certain disciplinary proceedings to written statements made under oath.
C.S.H.B. 3040 requires the medical board to enter into a memorandum of understanding, which must be adopted by rule, with the governing board of the Texas Physician Health Program not later than January 1, 2018, to better coordinate services and operations of the program and sets out provisions relating to the memorandum. The bill authorizes the governing board, in addition to any fees paid to the board or money appropriated to the board for the program, to receive and accept a gift, grant, donation or other thing of value from any source for the program.
C.S.H.B. 3040 specifies that the pain management clinics the medical board may inspect as necessary to ensure compliance with certain regulations are certified clinics but authorizes the board to inspect a clinic or facility that is not certified to determine whether the clinic or facility is required to be certified. The bill requires the medical board by rule to establish the grounds for conducting such an inspection, including certain specified grounds. The bill establishes that for purposes of regulating persons affiliated with a pain management clinic inappropriate prescribing includes nontherapeutic prescribing or other conduct as specified by board rule.
C.S.H.B. 3040 provides for the adoption of the Interstate Medical Licensure Compact, the creation of the Interstate Medical Licensure Compact Commission, and sets out the contents of the compact, including provisions providing for withdrawal from the compact and the dissolution of the compact. The bill authorizes the medical board to adopt rules necessary to implement the compact and provides for the board's authority to collect fingerprints for an expedited medical license under the compact.
C.S.H.B. 3040 authorizes the physician assistant board to conduct deliberations relating to a license application or disciplinary action in an executive session after hearing all evidence and arguments in an open meeting but requires the board to vote and announce its decision in open session.
C.S.H.B. 3040 requires the physician assistant board, the acupuncture board, and the medical board to require an applicant for a license issued under the Physician Assistant Licensing Act, a license to practice acupuncture, or a surgical assistant license, as applicable, to submit a complete and legible set of fingerprints, on a form prescribed by the applicable board, to the board or to the Department of Public Safety (DPS) for the purpose of obtaining criminal history record information from DPS and the Federal Bureau of Investigation (FBI). The bill prohibits the physician assistant board, the acupuncture board, and the medical board from issuing the applicable license to a person who does not comply with that requirement and requires each such board to conduct a criminal history record information check of each applicable license applicant using the set of fingerprints and information made available to the board by DPS, the FBI, and any other criminal justice agency. The bill authorizes the physician assistant board, the acupuncture board and the medical board, respectively, to enter into an agreement with DPS to administer the required criminal history record information check and to authorize DPS to collect from each applicant the costs incurred by DPS in conducting the criminal history record information check.
C.S.H.B. 3040 requires an applicant for renewal of a license issued under the Physician Assistant Licensing Act, a license to practice acupuncture, or a surgical assistant license to submit a complete and legible set of fingerprints for purposes of performing the required criminal history record information check of license applicants and authorizes the physician assistant board, the acupuncture board, and the medical board to administratively suspend or refuse to renew the applicable license of a person who does not comply with that requirement. Such a license holder is expressly not required to submit fingerprints as required by the bill for the renewal of the license if the holder has previously submitted fingerprints for the initial issuance of the license or as part of a prior license renewal. The bill requires the physician assistant board, the acupuncture board, and the medical board to obtain criminal history record information on each person who, on the bill's effective date, holds such a license, as applicable, and who did not undergo a criminal history record information check based on the license holder's fingerprints on the initial application for the license not later than September 1, 2019, and authorizes each such board to suspend the license of an applicable license holder who does not provide the criminal history record information as required by the board and the bill.
C.S.H.B. 3040 removes the requirement that an applicant for a license as a surgical assistant or a license issued under the Physician Assistant Licensing Act be of good moral character to be eligible for the license and makes a license issued under the Physician Assistant Licensing Act valid for a term of one or two years, as determined by physician assistant board rule. The bill requires at least one of the panelists at an informal meeting of the physician assistant board to consider a contested licensure case to be a licensed physician assistant. The bill authorizes the medical board to provide by rule for the biennial renewal of a license to practice acupuncture as an alternative to annual license renewal.
C.S.H.B. 3040 requires the Texas Board of Medical Radiological Technology by rule to establish the education and training required for a person to obtain a radiologist assistant certificate and requires the Texas Medical Board to approve those rules not later than January 1, 2018. The bill authorizes the holder of such a certificate to perform radiologic procedures only under the supervision of a certified or board-eligible radiologist and prohibits the certificate holder from interpreting images, making diagnoses, or prescribing any medication or therapy. The bill authorizes the Texas Board of Medical Radiological Technology to issue a temporary radiologist assistant certificate to a person that authorizes the person to perform applicable radiologic procedures for a period capped at one year.
C.S.H.B. 3040 includes as a required condition for consideration for a hardship exemption from the mandatory training for certain persons who intentionally use radiologic technology the condition that the applicant for the exemption is located in a county with a population of less than 50,000. The bill removes the requirement that the application submitted for a perfusionist license be a sworn application.
C.S.H.B. 3040 limits the applicability of certain requirements for rules adopted by specified boards regulating the manner in which certain licensees may order, instruct, or direct another authorized person in the performance of a radiologic procedure to rules adopted by the State Board of Dental Examiners.
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EFFECTIVE DATE
September 1, 2017.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 3040 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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