85R6881 BEE-D
 
  By: Buckingham, et al. S.B. No. 1148
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to maintenance of certification by a physician or an
  applicant for a license to practice medicine in this state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle F, Title 8, Insurance Code, is amended
  by adding Chapter 1461 to read as follows:
  CHAPTER 1461. DISCRIMINATION AGAINST PHYSICIAN BASED ON
  MAINTENANCE OF CERTIFICATION
         Sec. 1461.001.  DEFINITIONS. In this chapter:
               (1)  "Enrollee" means an individual who is eligible to
  receive health care services under a managed care plan.
               (2)  "Maintenance of certification" has the meaning
  assigned by Section 151.002, Occupations Code.
               (3)  "Managed care plan" means a health benefit plan
  under which medical care services are provided to enrollees through
  contracts with physicians and that requires enrollees to use
  participating physicians or that provides a different level of
  coverage for enrollees who use participating physicians.  The term
  includes a health benefit plan issued by:
                     (A)  a health maintenance organization;
                     (B)  a preferred provider benefit plan issuer; or
                     (C)  any other entity that issues a health benefit
  plan, including an insurance company.
               (4)  "Participating physician" means a physician who
  has directly or indirectly contracted with a health benefit plan
  issuer to provide services to enrollees.
               (5)  "Physician" means a person licensed to practice
  medicine in this state.
         Sec. 1461.002.  APPLICABILITY. (a)  This chapter applies to
  a physician regardless of whether the physician is a participating
  physician.
         (b)  This chapter applies to a person to whom a managed care
  plan issuer contracts to:
               (1)  process or pay claims;
               (2)  obtain the services of physicians to provide
  medical care services to enrollees; or
               (3)  issue verifications or preauthorizations.
         Sec. 1461.003.  DISCRIMINATION BASED ON MAINTENANCE OF
  CERTIFICATION. A managed care plan issuer may not differentiate
  between physicians based solely on a physician's maintenance of
  certification in regard to:
               (1)  paying the physician;
               (2)  reimbursing the physician; or 
               (3)  directly or indirectly contracting with the
  physician to provide services to enrollees.
         SECTION 2.  Section 151.002(a), Occupations Code, is amended
  by adding Subdivision (6-b) to read as follows:
               (6-b)  "Maintenance of certification" means the
  satisfactory completion of periodic recertification examinations
  required to maintain certification after an initial certification
  under a medical specialty member board, including the member boards
  of the American Board of Medical Specialties or the specialty
  certifying boards of the American Osteopathic Association.
         SECTION 3.  Subchapter B, Chapter 151, Occupations Code, is
  amended by adding Section 151.0515 to read as follows:
         Sec. 151.0515.  DISCRIMINATION BASED ON MAINTENANCE OF
  CERTIFICATION. A hospital, institution, or program that is
  licensed by this state, is operated by this state or a political
  subdivision of this state, or directly or indirectly receives state
  financial assistance may not differentiate between physicians
  based solely on a physician's maintenance of certification.
         SECTION 4.  Section 155.003, Occupations Code, is amended by
  amending Subsection (d) and adding Subsection (d-1) to read as
  follows:
         (d)  Except as provided by Subsection (d-1), in [In] addition
  to the other requirements prescribed by this subtitle, the board
  may require an applicant to comply with other requirements that the
  board considers appropriate.
         (d-1)  The board may not require maintenance of
  certification by an applicant for the applicant to be eligible for a
  license under this chapter.
         SECTION 5.  Section 156.001, Occupations Code, is amended by
  adding Subsection (f) to read as follows:
         (f)  The board may not adopt a rule requiring maintenance of
  certification by a license holder for the license holder to be
  eligible for an initial or renewal registration permit.
         SECTION 6.  This Act takes effect September 1, 2017.