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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. |
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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 HEALTH ORGANIZATIONS. (a) The board shall accept and |
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process complaints against a health organization certified under |
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Section 162.001(b) for alleged violations of this subchapter or any |
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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) notify the health organization that is the subject |
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of a complaint filed with the board, disclose the nature of the |
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complaint, and provide the health organization with an opportunity |
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to respond to 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) Nothing in this Section shall be construed to either |
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sanction or prohibit an individual from, separately or |
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contemporaneously with a complaint to the board, initiating a |
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complaint directly to the health organization certified under |
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Section 162.001(b) relating to: |
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(1) care or services provided by, or policies of, the |
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health organization; |
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(2) alleged violations of this subchapter; or |
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(3) any other provision of this subtitle applicable to |
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a health organization. |
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Sec. 162.005. ANTI-RETALIATION POLICY. (a) A health |
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organization shall develop, implement, and comply with an |
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anti-retaliation policy extending to physicians that provides the |
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health organization may not terminate, demote, retaliate against, |
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discipline, discriminate against, or otherwise penalize a person, |
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because the person: |
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(1) files reasonably and in good faith a complaint |
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under Section 162.004; |
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(2) cooperates, reasonably and in good faith, in an |
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investigation or proceeding of the board relating to a complaint |
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filed under Section 162.004; or |
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(3) communicates to a patient in good faith regarding |
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what he or she 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 has failed |
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to adopt, implement, or comply with a policy as described in |
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subsection (a), the board may exercise all remedies available |
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against a health organization allowed under this subchapter or |
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rules of the board. |
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Sec. 162.006. REPORTING REQUIREMENTS FOR 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 certified in an odd numbered |
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year, and in September of each even numbered year if certified in an |
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even numbered year, and the biennial report shall include the |
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following: |
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(1) a statement signed and verified by the president |
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or chief executive officer: |
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(A) indicating the name and mailing address of |
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the health organization; |
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(B) indicating the names and mailing addresses |
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of: |
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(1) all members or that there are no members; |
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(2) the chief executive officer, if any, |
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president, secretary and treasurer; |
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(3) members of the board of directors; and |
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(C) disclosing any changes in the composition of |
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the board of directors since the last biennial report. |
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(2) a statement signed and verified by the president |
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or chief executive officer attaching a copy of the current |
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certificate of incorporation and by-laws of the health organization |
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if not already on file with the board and indicating: |
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(A) whether or not the by-laws or articles of |
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incorporation of the health organization have been revised since |
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the last biennial report; |
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(B) whether or not such revisions, if any, were |
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recommended or approved by the board of directors; and |
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(C) a concise explanation of such revisions, if |
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any; |
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(3) statements signed and verified by each current |
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member of the board of directors indicating that such director: |
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(A) is licensed by the board; |
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(B) is actively engaged in the practice of |
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medicine and has no restrictions on his or her Texas medical |
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license; |
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(C) will, as a director, exercise independent |
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judgement in all matters and, specifically, matters relating to |
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credentialing, quality assurance, utilization review, peer review, |
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and the practice of medicine; |
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(D) will, as a director, exercise best efforts to |
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cause the health organization to comply with all relevant |
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provisions of this subtitle and board rules; |
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(E) will, as a director, immediately report to |
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the board any action or event which such director reasonably and in |
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good faith believes constitutes a violation or attempted violation |
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of this subtitle or board rules; and |
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(F) has disclosed the identity of all of such |
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director's financial relationships, if any, which such director has |
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with any member of the health organization, any other director, any |
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supplier of the health organization or any affiliate of any member |
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of the health organization, other director, or supplier of the |
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health organization and provided a concise explanation of the |
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nature of each such financial relationship within such director's |
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statement; |
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(4) a statement signed and verified by the president |
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or chief executive officer indicating that the health organization |
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is in compliance with the requirements for certification and |
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continued certification as required by the provisions of this |
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subtitle and board rules; and |
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(5) a fee in the amount and form specified by the board |
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relating to registration and renewal fees. |
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(b) On January 1 of each year, the board shall |
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electronically publish all materials described in subsection |
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(a)(1) for each health organization certified under Section |
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162.001(b). The information described in subsections (a)(2)-(4) is |
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public information available to members of the public under Chapter |
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552, Government Code. |
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(f) The board may adopt rules as 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 Sections 162.004 and 162.005, Occupations Code, as |
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added by this Act, apply only to a violation by a health |
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organization that occurs on or after the effective date of this Act. |
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A violation that occurs before the effective date of this Act is |
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governed by the law in effect on the date the violation occurred, |
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and the former law is continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2019. |