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