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A BILL TO BE ENTITLED
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AN ACT
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relating to the regulation of certain health organizations |
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certified by the Texas Medical Board; providing an administrative |
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penalty; authorizing a fee. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 162.003, Occupations Code, is amended to |
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read as follows: |
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Sec. 162.003. REFUSAL TO CERTIFY; REVOCATION; PENALTY. On |
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a determination that a health organization commits a violation of |
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this subtitle or is established, organized, or operated in |
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violation of or with the intent to violate this subtitle, the board |
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may: |
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(1) refuse to certify the health organization on |
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application for certification by the organization under Section |
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162.001; |
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(2) revoke a certification made under Section 162.001 |
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to that organization; or |
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(3) impose an administrative penalty against the |
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health organization under Subchapter A, Chapter 165. |
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SECTION 2. Subchapter A, Chapter 162, Occupations Code, is |
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amended by adding Sections 162.004, 162.005, and 162.006 to read as |
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follows: |
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Sec. 162.004. PROCEDURES FOR AND DISPOSITION OF COMPLAINTS |
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AGAINST CERTAIN HEALTH ORGANIZATIONS. (a) The board shall accept |
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and process complaints against a health organization certified |
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under Section 162.001(b) for alleged violations of this subchapter |
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or any other provision of this subtitle applicable to a health |
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organization in the same manner as provided under Subchapter B, |
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Chapter 154, and the rules adopted under that subchapter, including |
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the requirements to: |
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(1) maintain a system to promptly and efficiently act |
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on complaints filed with the board; |
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(2) with respect to a health organization that is the |
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subject of a complaint, notify the health organization that a |
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complaint has been filed, disclose the nature of the complaint, and |
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provide the health organization with an opportunity to respond to |
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the complaint; |
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(3) ensure that a complaint is not dismissed without |
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appropriate consideration; and |
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(4) establish methods by which physicians employed by |
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a health organization are notified of the name, mailing address, |
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and telephone number of the board for the purpose of directing |
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complaints under this section to the board. |
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(b) Each complaint, adverse report, investigation file, |
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other investigation report, and other investigative information in |
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the possession of or received or gathered by the board or the |
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board's employees or agents relating to a health organization |
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certified under Section 162.001(b) is privileged and confidential |
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and is not subject to discovery, subpoena, or other means of legal |
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compulsion for release to anyone other than the board or the board's |
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employees or agents involved in the investigation or discipline of |
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a health organization certified under Section 162.001(b). |
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(c) The board may dispose of a complaint or resolve the |
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investigation of a complaint under this section in a manner |
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provided under Subchapter A, Chapter 164, to the extent the board |
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determines the provisions of that subchapter can be made applicable |
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to a health organization certified under Section 162.001. |
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(d) This section does not require an individual to file or |
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prohibit an individual from filing a complaint against a health |
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organization certified under Section 162.001(b) directly with the |
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health organization, alone or in connection with a complaint filed |
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with the board under this section, relating to: |
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(1) the care or services provided by, or the policies |
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of, the health organization; or |
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(2) an alleged violation by the health organization of |
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this subchapter or any other provision of this subtitle applicable |
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to the health organization. |
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Sec. 162.005. ANTI-RETALIATION POLICY. (a) A health |
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organization certified under Section 162.001(b) shall develop, |
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implement, and comply with an anti-retaliation policy for |
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physicians under which the health organization may not terminate, |
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demote, retaliate against, discipline, discriminate against, or |
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otherwise penalize a physician for: |
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(1) filing in good faith a complaint under Section |
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162.004; |
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(2) cooperating in good faith with an investigation or |
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proceeding of the board relating to a complaint filed under Section |
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162.004; or |
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(3) communicating to a patient in good faith what the |
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physician reasonably believes to be the physician's best, |
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independent medical judgment. |
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(b) On a determination that a health organization certified |
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under Section 162.001(b) has failed to develop, implement, or |
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comply with a policy described by Subsection (a), the board may take |
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any action allowed under this subtitle or board rule applicable to a |
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health organization. |
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Sec. 162.006. BIENNIAL REPORT REQUIRED FOR CERTAIN HEALTH |
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ORGANIZATIONS. (a) Each health organization certified under |
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Section 162.001(b) shall file with the board a biennial report in |
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September of each odd-numbered year if the organization was |
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certified in an odd-numbered year or in September of each |
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even-numbered year if the organization was certified in an |
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even-numbered year. The biennial report must include: |
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(1) a statement signed and verified by the president |
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or chief executive officer of the health organization that: |
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(A) provides the name and mailing address of: |
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(i) the health organization; |
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(ii) each member of the health |
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organization, except that if the health organization has no |
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members, a statement indicating that fact; |
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(iii) each member of the board of directors |
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of the health organization; and |
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(iv) each officer of the health |
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organization; and |
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(B) discloses any change in the composition of |
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the board of directors since the date of the most recent biennial |
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report; |
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(2) a statement signed and verified by the president |
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or chief executive officer of the health organization that: |
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(A) indicates whether the health organization's |
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certificate of formation or bylaws were amended since the date of |
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the most recent biennial report; |
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(B) if applicable, provides a concise |
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explanation of the amendments and states whether the amendments |
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were recommended or approved by the board of directors; and |
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(C) has attached to the statement a copy of the |
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organization's current certificate of formation and bylaws if a |
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copy is not already on file with the board; |
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(3) a statement from each current director of the |
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health organization, signed and verified by the director: |
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(A) stating that the director is licensed by the |
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board to practice medicine, is actively engaged in the practice of |
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medicine, and has no restrictions on the director's license; |
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(B) stating that the director will, as a |
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director: |
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(i) exercise independent judgment in all |
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matters, specifically including matters relating to credentialing, |
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quality assurance, utilization review, peer review, and the |
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practice of medicine; |
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(ii) exercise best efforts to cause the |
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health organization to comply with all relevant provisions of this |
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subtitle and board rules; and |
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(iii) immediately report to the board any |
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action or event the director reasonably and in good faith believes |
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constitutes a violation or attempted violation of this subtitle or |
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board rules; |
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(C) identifying and concisely explaining the |
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nature of each financial relationship the director has, if any, |
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with a member, another director, or a supplier of the health |
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organization or an affiliate of those persons; and |
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(D) stating that the director has disclosed all |
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financial relationships described by Paragraph (C); and |
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(4) a statement signed and verified by the president |
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or chief executive officer of the health organization indicating |
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that the health organization is in compliance with the requirements |
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for continued certification provided by this subtitle and board |
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rules. |
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(b) A health organization required to submit a biennial |
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report under Subsection (a) shall submit with the report a fee in |
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the amount prescribed by board rule. |
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(c) Not later than January 1 of each year, the board shall |
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publish on the board's Internet website the information provided to |
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the board in each statement under Subsection (a)(1). |
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(d) Information provided to the board in each statement |
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under Subsections (a)(2), (3), and (4) is public information |
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subject to disclosure under Chapter 552, Government Code. |
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(e) The board may adopt rules necessary to implement this |
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section. |
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SECTION 3. Section 162.003, Occupations Code, as amended by |
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this Act, and Section 162.004, Occupations Code, as added by this |
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Act, apply only to a violation by a health organization that occurs |
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on or after the effective date of this Act. A violation that occurs |
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before the effective date of this Act is governed by the law in |
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effect on the date the violation occurred, and the former law is |
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continued in effect for that purpose. |
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SECTION 4. Not later than December 31, 2019, a health |
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organization certified under Section 162.001(b), Occupations Code, |
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shall develop the anti-retaliation policy required by Section |
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162.005, Occupations Code, as added by this Act. |
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SECTION 5. (a) Except as provided by Subsection (b) of this |
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section, this Act takes effect September 1, 2019. |
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(b) Section 162.005(b), Occupations Code, as added by this |
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Act, takes effect January 1, 2020. |
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