By: Buckingham, et al.  S.B. No. 1148
         (In the Senate - Filed February 28, 2017; March 7, 2017,
  read first time and referred to Committee on Business & Commerce;
  April 24, 2017, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 8, Nays 0; April 24, 2017,
  sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 1148 By:  Campbell
 
 
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;
  authorizing a fee.
         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)  Except as provided by Subsection (b), a
  managed care plan issuer may not differentiate between physicians
  based 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.
         (b)  A managed care plan issuer may differentiate between
  physicians based on a physician's maintenance of certification
  only:
               (1)  if the entity that administers the physician's
  maintenance of certification is certified under Chapter 170,
  Occupations Code; and
               (2)  after the issuer considers the physician's:
                     (A)  training;
                     (B)  experience;
                     (C)  competence; and
                     (D)  judgment.
         (c)  A managed care plan issuer may not differentiate between
  physicians based on the entity that administers a physician's
  maintenance of certification.
         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 requirements
  that are required for a physician to maintain certification after
  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 A, Chapter 151, Occupations Code, is
  amended by adding Section 151.006 to read as follows:
         Sec. 151.006.  CERTIFICATION OF MEDICAL SPECIALTY.
  Notwithstanding any other law, a physician is considered a
  board-certified medical specialist in this state if the physician
  receives initial certification by a medical specialty board,
  regardless of the physician's maintenance of certification.
         SECTION 4.  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)  Except as provided by Subsection (b), 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 on a physician's
  maintenance of certification.
         (b)  An entity described by Subsection (a) may differentiate
  between physicians based on a physician's maintenance of
  certification only:
               (1)  if the entity that administers the physician's
  maintenance of certification is certified under Chapter 170; and
               (2)  after the entity considers the physician's:
                     (A)  training;
                     (B)  experience;
                     (C)  competence; and
                     (D)  judgment.
         (c)  An entity described by Subsection (a) may not
  differentiate between physicians based on the entity that
  administers a physician's maintenance of certification.
         (d)  A state agency, including the Health and Human Services
  Commission and the Department of State Health Services, may not
  require a hospital or other provider to require maintenance of
  certification by a physician.
         SECTION 5.  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 6.  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 7.  Subtitle B, Title 3, Occupations Code, is
  amended by adding Chapter 170 to read as follows:
  CHAPTER 170. ENTITY CERTIFICATION TO PROVIDE MAINTENANCE OF
  CERTIFICATION
         Sec. 170.001.  CERTIFICATE TO PROVIDE MAINTENANCE OF
  CERTIFICATION. (a)  The board shall establish a process to issue a
  certificate authorizing an entity to provide maintenance of
  certification for physicians.
         (b)  The board by rule shall establish the minimum number of
  continuing medical education hours that are required for
  maintenance of certification in a particular medical specialty by
  an entity under this chapter.
         Sec. 170.002.  FEES. The board may set a reasonable
  application fee for a certificate under this chapter.
         Sec. 170.003.  APPLICATION FOR CERTIFICATE. (a)  The board
  shall prescribe the form of an application for a certificate under
  this chapter.
         (b)  The application must require the applicant to provide:
               (1)  the applicant's legal name, mailing address,
  telephone number, and business address;
               (2)  the particular practice area in which the
  applicant will offer maintenance of certification; 
               (3)  the requirements the applicant will impose on a
  physician for maintenance of certification; and
               (4)  the amount of any fees the applicant will charge a
  physician for maintenance of certification.
         Sec. 170.004.  ISSUANCE OF CERTIFICATE. The board shall
  issue a certificate under this chapter to an applicant that:
               (1)  submits an application on the form prescribed by
  the board under Section 170.003;
               (2)  pays the required fee; and
               (3)  demonstrates to the satisfaction of the board that
  the applicant's maintenance of certification program complies with
  Sections 170.005 and 170.006.
         Sec. 170.005.  REQUIREMENTS FOR MAINTENANCE OF
  CERTIFICATION. A maintenance of certification program provided by
  a holder of a certificate under this chapter:
               (1)  must require a physician seeking maintenance of
  certification to complete at least the minimum number of continuing
  medical education hours set by board rule under Section 170.001(b);
  and
               (2)  other than continuing medical education hours, may
  not require a physician initially certified by the entity to
  complete any educational or testing requirement, including
  periodic testing, proprietary self-assessment, or peer evaluation.
         Sec. 170.006.  PRACTICE IMPROVEMENT PROGRAM. (a)  A holder
  of a certificate under this chapter shall administer a practice
  improvement program to encourage continued improvement within the
  medical profession.
         (b)  A practice improvement program under Subsection (a)
  must focus on recent scientific developments, improving patient
  safety, patient or population health outcomes, access to health
  care, and patient experience, and increasing value in the health
  care system.
         Sec. 170.007.  ADVERTISING AS BOARD-CERTIFIED SPECIALIST. A
  physician who holds current maintenance of certification from a
  certificate holder under this chapter may advertise that the
  physician is a board-certified specialist in the area of medical
  specialty in which the physician holds the maintenance of
  certification.
         SECTION 8.  The Texas Medical Board shall adopt rules to
  implement Chapter 170, Occupations Code, as added by this Act, not
  later than September 1, 2018.
         SECTION 9.  This Act takes effect January 1, 2018.
 
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