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A BILL TO BE ENTITLED
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AN ACT
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relating to maintenance of certification by a physician or an |
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applicant for a license to practice medicine in this state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle F, Title 8, Insurance Code, is amended |
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by adding Chapter 1461 to read as follows: |
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CHAPTER 1461. DISCRIMINATION AGAINST PHYSICIAN BASED ON |
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MAINTENANCE OF CERTIFICATION |
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Sec. 1461.001. DEFINITIONS. In this chapter: |
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(1) "Enrollee" means an individual who is eligible to |
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receive health care services under a managed care plan. |
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(2) "Maintenance of certification" has the meaning |
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assigned by Section 151.002, Occupations Code. |
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(3) "Managed care plan" means a health benefit plan |
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under which medical care services are provided to enrollees through |
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contracts with physicians and that requires enrollees to use |
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participating physicians or that provides a different level of |
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coverage for enrollees who use participating physicians. The term |
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includes a health benefit plan issued by: |
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(A) a health maintenance organization; |
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(B) a preferred provider benefit plan issuer; or |
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(C) any other entity that issues a health benefit |
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plan, including an insurance company. |
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(4) "Participating physician" means a physician who |
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has directly or indirectly contracted with a health benefit plan |
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issuer to provide services to enrollees. |
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(5) "Physician" means a person licensed to practice |
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medicine in this state. |
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Sec. 1461.002. APPLICABILITY. (a) This chapter applies to |
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a physician regardless of whether the physician is a participating |
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physician. |
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(b) This chapter applies to a person to whom a managed care |
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plan issuer contracts to: |
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(1) process or pay claims; |
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(2) obtain the services of physicians to provide |
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medical care services to enrollees; or |
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(3) issue verifications or preauthorizations. |
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Sec. 1461.003. DISCRIMINATION BASED ON MAINTENANCE OF |
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CERTIFICATION. A managed care plan issuer may not differentiate |
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between physicians based solely on a physician's maintenance of |
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certification in regard to: |
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(1) paying the physician; |
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(2) reimbursing the physician; or |
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(3) directly or indirectly contracting with the |
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physician to provide services to enrollees. |
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SECTION 2. Section 151.002(a), Occupations Code, is amended |
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by adding Subdivision (6-b) to read as follows: |
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(6-b) "Maintenance of certification" means the |
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satisfactory completion of periodic recertification examinations |
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required to maintain certification after an initial certification |
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under a medical specialty member board, including the member boards |
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of the American Board of Medical Specialties or the specialty |
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certifying boards of the American Osteopathic Association. |
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SECTION 3. Subchapter B, Chapter 151, Occupations Code, is |
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amended by adding Section 151.0515 to read as follows: |
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Sec. 151.0515. DISCRIMINATION BASED ON MAINTENANCE OF |
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CERTIFICATION. A hospital, institution, or program that is |
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licensed by this state, is operated by this state or a political |
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subdivision of this state, or directly or indirectly receives state |
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financial assistance may not differentiate between physicians |
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based solely on a physician's maintenance of certification. |
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SECTION 4. Section 155.003, Occupations Code, is amended by |
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amending Subsection (d) and adding Subsection (d-1) to read as |
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follows: |
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(d) Except as provided by Subsection (d-1), in [In] addition |
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to the other requirements prescribed by this subtitle, the board |
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may require an applicant to comply with other requirements that the |
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board considers appropriate. |
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(d-1) The board may not require maintenance of |
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certification by an applicant for the applicant to be eligible for a |
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license under this chapter. |
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SECTION 5. Section 156.001, Occupations Code, is amended by |
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adding Subsection (f) to read as follows: |
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(f) The board may not adopt a rule requiring maintenance of |
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certification by a license holder for the license holder to be |
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eligible for an initial or renewal registration permit. |
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SECTION 6. This Act takes effect September 1, 2017. |