By: Meyer (Senate Sponsor - Hughes) H.B. No. 1532
         (In the Senate - Received from the House May 2, 2019;
  May 3, 2019, read first time and referred to Committee on Health &
  Human Services; May 20, 2019, reported favorably by the following
  vote:  Yeas 9, Nays 0; May 20, 2019, sent to printer.)
Click here to see the committee vote
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the regulation of certain health organizations
  certified by the Texas Medical Board; providing an administrative
  penalty; authorizing a fee.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 162.003, Occupations Code, is amended to
  read as follows:
         Sec. 162.003.  REFUSAL TO CERTIFY; REVOCATION; PENALTY. On
  a determination that a health organization commits a violation of
  this subtitle or is established, organized, or operated in
  violation of or with the intent to violate this subtitle, the board
  may:
               (1)  refuse to certify the health organization on
  application for certification by the organization under Section
  162.001;
               (2)  revoke a certification made under Section 162.001
  to that organization; or
               (3)  impose an administrative penalty against the
  health organization under Subchapter A, Chapter 165.
         SECTION 2.  Subchapter A, Chapter 162, Occupations Code, is
  amended by adding Sections 162.004, 162.005, and 162.006 to read as
  follows:
         Sec. 162.004.  PROCEDURES FOR AND DISPOSITION OF COMPLAINTS
  AGAINST CERTAIN HEALTH ORGANIZATIONS. (a) The board shall accept
  and process complaints against a health organization certified
  under Section 162.001(b) for alleged violations of this subchapter
  or any other provision of this subtitle applicable to a health
  organization in the same manner as provided under Subchapter B,
  Chapter 154, and the rules adopted under that subchapter, including
  the requirements to:
               (1)  maintain a system to promptly and efficiently act
  on complaints filed with the board;
               (2)  with respect to a health organization that is the
  subject of a complaint, notify the health organization that a
  complaint has been filed, disclose the nature of the complaint, and
  provide the health organization with an opportunity to respond to
  the complaint;
               (3)  ensure that a complaint is not dismissed without
  appropriate consideration; and
               (4)  establish methods by which physicians employed by
  a health organization are notified of the name, mailing address,
  and telephone number of the board for the purpose of directing
  complaints under this section to the board.
         (b)  Each complaint, adverse report, investigation file,
  other investigation report, and other investigative information in
  the possession of or received or gathered by the board or the
  board's employees or agents relating to a health organization
  certified under Section 162.001(b) is privileged and confidential
  and is not subject to discovery, subpoena, or other means of legal
  compulsion for release to anyone other than the board or the board's
  employees or agents involved in the investigation or discipline of
  a health organization certified under Section 162.001(b).
         (c)  The board may dispose of a complaint or resolve the
  investigation of a complaint under this section in a manner
  provided under Subchapter A, Chapter 164, to the extent the board
  determines the provisions of that subchapter can be made applicable
  to a health organization certified under Section 162.001.
         (d)  This section does not require an individual to file or
  prohibit an individual from filing a complaint against a health
  organization certified under Section 162.001(b) directly with the
  health organization, alone or in connection with a complaint filed
  with the board under this section, relating to:
               (1)  the care or services provided by, or the policies
  of, the health organization; or
               (2)  an alleged violation by the health organization of
  this subchapter or any other provision of this subtitle applicable
  to the health organization.
         Sec. 162.005.  ANTI-RETALIATION POLICY. (a) A health
  organization certified under Section 162.001(b) shall develop,
  implement, and comply with an anti-retaliation policy for
  physicians under which the health organization may not terminate,
  demote, retaliate against, discipline, discriminate against, or
  otherwise penalize a physician for:
               (1)  filing in good faith a complaint under Section
  162.004;
               (2)  cooperating in good faith with an investigation or
  proceeding of the board relating to a complaint filed under Section
  162.004; or
               (3)  communicating to a patient in good faith what the
  physician reasonably believes to be the physician's best,
  independent medical judgment.
         (b)  On a determination that a health organization certified
  under Section 162.001(b) has failed to develop, implement, or
  comply with a policy described by Subsection (a), the board may take
  any action allowed under this subtitle or board rule applicable to a
  health organization.
         Sec. 162.006.  BIENNIAL REPORT REQUIRED FOR CERTAIN HEALTH
  ORGANIZATIONS. (a) Each health organization certified under
  Section 162.001(b) shall file with the board a biennial report in
  September of each odd-numbered year if the organization was
  certified in an odd-numbered year or in September of each
  even-numbered year if the organization was certified in an
  even-numbered year. The biennial report must include:
               (1)  a statement signed and verified by the president
  or chief executive officer of the health organization that:
                     (A)  provides the name and mailing address of:
                           (i)  the health organization;
                           (ii)  each member of the health
  organization, except that if the health organization has no
  members, a statement indicating that fact;
                           (iii)  each member of the board of directors
  of the health organization; and
                           (iv)  each officer of the health
  organization; and
                     (B)  discloses any change in the composition of
  the board of directors since the date of the most recent biennial
  report;
               (2)  a statement signed and verified by the president
  or chief executive officer of the health organization that:
                     (A)  indicates whether the health organization's
  certificate of formation or bylaws were amended since the date of
  the most recent biennial report;
                     (B)  if applicable, provides a concise
  explanation of the amendments and states whether the amendments
  were recommended or approved by the board of directors; and
                     (C)  has attached to the statement a copy of the
  organization's current certificate of formation and bylaws if a
  copy is not already on file with the board;
               (3)  a statement from each current director of the
  health organization, signed and verified by the director:
                     (A)  stating that the director is licensed by the
  board to practice medicine, is actively engaged in the practice of
  medicine, and has no restrictions on the director's license;
                     (B)  stating that the director will, as a
  director:
                           (i)  exercise independent judgment in all
  matters, specifically including matters relating to credentialing,
  quality assurance, utilization review, peer review, and the
  practice of medicine;
                           (ii)  exercise best efforts to cause the
  health organization to comply with all relevant provisions of this
  subtitle and board rules; and
                           (iii)  immediately report to the board any
  action or event the director reasonably and in good faith believes
  constitutes a violation or attempted violation of this subtitle or
  board rules;
                     (C)  identifying and concisely explaining the
  nature of each financial relationship the director has, if any,
  with a member, another director, or a supplier of the health
  organization or an affiliate of those persons; and
                     (D)  stating that the director has disclosed all
  financial relationships described by Paragraph (C); and
               (4)  a statement signed and verified by the president
  or chief executive officer of the health organization indicating
  that the health organization is in compliance with the requirements
  for continued certification provided by this subtitle and board
  rules.
         (b)  A health organization required to submit a biennial
  report under Subsection (a) shall submit with the report a fee in
  the amount prescribed by board rule.
         (c)  Not later than January 1 of each year, the board shall
  publish on the board's Internet website the information provided to
  the board in each statement under Subsection (a)(1).
         (d)  Information provided to the board in each statement
  under Subsections (a)(2), (3), and (4) is public information
  subject to disclosure under Chapter 552, Government Code.
         (e)  The board may adopt rules necessary to implement this
  section.
         SECTION 3.  Section 162.003, Occupations Code, as amended by
  this Act, and Section 162.004, Occupations Code, as added by this
  Act, apply only to a violation by a health organization that occurs
  on or after the effective date of this Act. A violation that occurs
  before the effective date of this Act is governed by the law in
  effect on the date the violation occurred, and the former law is
  continued in effect for that purpose.
         SECTION 4.  Not later than December 31, 2019, a health
  organization certified under Section 162.001(b), Occupations Code,
  shall develop the anti-retaliation policy required by Section
  162.005, Occupations Code, as added by this Act.
         SECTION 5.  (a) Except as provided by Subsection (b) of this
  section, this Act takes effect September 1, 2019.
         (b)  Section 162.005(b), Occupations Code, as added by this
  Act, takes effect January 1, 2020.
 
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