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  82R8165 YDB-F
 
  By: Thompson H.B. No. 1809
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the registration of diagnostic imaging equipment, the
  accreditation of diagnostic imaging facilities, and the regulation
  of diagnostic imaging providers; providing penalties.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle A, Title 3, Occupations Code, is
  amended by adding Chapter 113 to read as follows:
  CHAPTER 113.  DIAGNOSTIC IMAGING
  SUBCHAPTER A.  GENERAL PROVISIONS
         Sec. 113.001.  DEFINITIONS.  In this chapter:
               (1)  "Department" means the Department of State Health
  Services.
               (2)  "Diagnostic imaging equipment" means a machine or
  equipment used to provide a diagnostic imaging service to a
  patient.
               (3)  "Diagnostic imaging facility" means any facility,
  office, clinic, imaging center, hospital, or other location where a
  diagnostic imaging service is provided to a patient for a fee.
               (4)  "Diagnostic imaging provider" means a health care
  provider who performs a diagnostic imaging service on a patient for
  a fee at a diagnostic imaging facility.
               (5)  "Diagnostic imaging service" means magnetic
  resonance imaging, computed tomography, positron emission
  tomography, or any hybrid technology that combines any of those
  imaging modalities.
               (6)  "Health care provider" means a person licensed as
  a health care professional or authorized to practice in health care
  under Subtitle B, C, or E.
               (7)  "Patient" means a person who receives a physical
  examination, evaluation, diagnosis, or treatment from a health care
  provider.
               (8)  "Referral" means a health care provider's request
  for or ordering of a diagnostic imaging service for a patient.
         Sec. 113.002.  RULES.  The executive commissioner of the
  Health and Human Services Commission, on behalf of the department
  and as necessary to protect the public health and safety, shall
  adopt rules specifying the procedures health care providers and
  diagnostic imaging providers must use to comply with this chapter.
  [Sections 113.003-113.050 reserved for expansion]
  SUBCHAPTER B. REGISTRATION OF FACILITIES
         Sec. 113.051.  REGISTRATION REQUIRED.  Except as provided by
  Section 113.052, a person may not operate a diagnostic imaging
  facility in this state unless the person holds a diagnostic imaging
  facility certificate of registration issued under this subchapter.
         Sec. 113.052.  EXEMPTIONS FROM REGISTRATION REQUIREMENT.
  The following facilities are not required to be registered under
  this chapter:
               (1)  a birthing center licensed under Chapter 244,
  Health and Safety Code; and
               (2)  a hospital licensed under Chapter 241, Health and
  Safety Code.
         Sec. 113.053.  APPLICATION; ISSUANCE.  (a)  An applicant for
  a diagnostic imaging facility certificate of registration shall
  submit to the department an application on the form prescribed by
  the department.
         (b)  The department shall issue a diagnostic imaging
  facility certificate of registration to an applicant if:
               (1)  the applicant pays any required fee; and
               (2)  the department determines the applicant's facility
  meets the accreditation requirements under Section 113.054 and
  department rule.
         Sec. 113.054.  ACCREDITATION OF FACILITIES.  (a)  The
  department may not issue a diagnostic imaging facility certificate
  of registration to a person unless the person's diagnostic imaging
  facility has been accredited by a nationally recognized
  accreditation organization approved by the department.
         (b)  In approving accreditation organizations, the
  department shall consider:
               (1)  the ability of the organization to conduct timely
  reviews of accreditation applications;
               (2)  the organization's process for timely integration
  of new technology into accreditation programs;
               (3)  whether the organization's criteria for
  accreditation of diagnostic imaging facilities includes all of the
  following:
                     (A)  qualifications for health care providers and
  medical personnel providing health care services at the facility;
                     (B)  qualifications for and responsibilities of
  medical directors, supervising health care providers, and
  interpreting health care providers providing services at the
  facility;
                     (C)  procedures for ensuring that diagnostic
  imaging equipment complies with established performance
  specifications, such as an independent assessment of image quality
  and dose and an annual survey by a medical physicist that includes
  dose measurements;
                     (D)  procedures for ensuring that the images
  produced by the equipment are of diagnostic quality, including
  through direct visual evaluation of representative images by a
  physician trained in medical imaging;
                     (E)  procedures for ensuring patient safety; and
                     (F)  quality assurance reporting; and
               (4)  any other factors the department considers
  necessary to protect the health and safety of facility patients and
  the public.
         Sec. 113.055.  TERM; RENEWAL.  (a)  A diagnostic imaging
  facility certificate of registration expires on the second
  anniversary of the date of issuance.
         (b)  A person may renew a diagnostic imaging facility
  certificate of registration by submitting to the department on the
  form prescribed by the department a renewal application and any fee
  required by the department.
  [Sections 113.056-113.070 reserved for expansion]
  SUBCHAPTER B-1.  REPORTING AND DISCLOSURE OF HEALTH CARE PROVIDER
  REFERRALS
         Sec. 113.071.  DEFINITIONS.  In this subchapter:
               (1)  "Immediate family member" means a person's spouse,
  child, child's spouse, grandchild, grandchild's spouse, parent,
  parent-in-law, or sibling.
               (2)  "Investment interest" means:
                     (A)  an equity or debt security issued by a
  person, including:
                           (i)  shares of stock in a corporation;
                           (ii)  membership or other interest in a
  company, including a limited liability company;
                           (iii)  units or other interests in a
  partnership, including a limited liability partnership; and
                           (iv)  bonds, debentures, notes, or other
  equity interests or debt instruments; and
                     (B)  the rental or time sharing of imaging
  equipment and office space in which a referring health care
  provider receives a portion of the billing revenue.
               (3)  "Investor" means a person who directly or
  indirectly holds a legal, beneficial ownership, or investment
  interest, including an interest held through an immediate family
  member, a trust, or another person related to the investor within
  the meaning of "related to the provider" as defined by 42 C.F.R.
  Section 413.17.
               (4)  "Licensing authority" means a department, board,
  office, or other agency of this state that regulates a health care
  provider subject to this chapter.
         Sec. 113.072.  REPORTING AND DISCLOSURE OF REFERRALS.  (a)  
  In this section, "third party payor" means:
               (1)  a person authorized to engage in business
  involving the payment of money or another thing of value in the
  event of loss resulting from disability incurred as a result of
  accident or sickness, as described in the Insurance Code;
               (2)  a health plan offered by an employer under the
  provisions of the Employee Retirement Income Security Act of 1974
  (29 U.S.C. Section 1001 et seq.);
               (3)  a publicly funded program of health care services,
  including Medicaid or the state child health plan; or
               (4)  any person, other than a patient, that pays a
  health care provider to provide designated health services or
  supplies, including an insurance company or a health maintenance
  organization.
         (b)  The owner or operator of a diagnostic imaging facility
  that provides a diagnostic imaging service for a referring health
  care provider shall report to the department:
               (1)  the identity of the referring health care
  provider;
               (2)  whether the referring health care provider is an
  investor in the diagnostic imaging facility and the exact nature of
  any legal, beneficial ownership, or investment interest the
  referring health care provider has in the diagnostic imaging
  facility;
               (3)  the total number of patients who received
  diagnostic imaging services at the diagnostic imaging facility and
  who were referred by the health care provider; and
               (4)  the additional claims data required by the
  department.
         (c)  A health care provider making a referral for diagnostic
  imaging services as described by this section must:
               (1)  disclose in writing to the provider's patients and
  any third party payor for a patient the provider's investment
  interest in the diagnostic imaging facility;
               (2)  advise the provider's patients and any third party
  payor for the patient that the patient may choose to have another
  diagnostic imaging facility provide the diagnostic imaging
  services; and
               (3)  obtain and record the patient's written consent
  after the disclosure and before the diagnostic imaging services are
  provided.
         (d)  The report required under Subsection (b) may be in the
  form of a bill for services provided by the diagnostic imaging
  facility in accordance with rules for filing a clean claim adopted
  by the Texas Department of Insurance (28 T.A.C. Section 21.2803),
  as those rules existed on September 1, 2011.
         (e)  A report required by this section must be submitted to
  the department in the format or method required by the department.
         Sec. 113.073.  PUBLIC INFORMATION.  Information collected
  under Section 113.072(b) shall be made available to the public.
         Sec. 113.074.  DISCIPLINARY ACTION.  A diagnostic imaging
  facility's failure to report information required by this
  subchapter is grounds for disciplinary action, including the
  imposition of an administrative penalty, by the department.
  [Sections 113.075-113.100 reserved for expansion]
  SUBCHAPTER C.  CIVIL PENALTY
         Sec. 113.101.  CIVIL PENALTY.  (a)  A person who operates a
  diagnostic imaging facility or a diagnostic imaging provider that
  violates this chapter or rules adopted under this chapter is
  subject to a civil penalty of not more than $1,000 for each
  violation.
         (b)  The attorney general at the request of the department
  shall bring an action to collect penalties under this section.  In
  the suit, the department and the attorney general each may recover
  reasonable expenses incurred in obtaining the penalty, including:
               (1)  investigation and court costs; and
               (2)  reasonable attorney's fees, witness fees, and
  deposition expenses.
         (c)  Expenses recovered by the department under this section
  shall be deposited in a separate account outside the state treasury
  to be used by the department in the enforcement of this chapter.
         SECTION 2.  (a)  The Department of State Health Services
  shall conduct a study of the information required to be submitted to
  the department under Subchapter B-1, Chapter 113, Occupations Code,
  as added by this Act.
         (b)  In conducting the study, the department shall compare
  the rates at which diagnostic imaging services were prescribed by
  health care providers of the same specialty who have legal,
  beneficial ownership, or investment interest in the diagnostic
  imaging services prescribed for the patient's care and those who do
  not have a legal, beneficial ownership, or investment interest in
  the prescribed diagnostic imaging services.
         (c)  Not later than January 1, 2013, the department shall
  submit a report regarding the study to the lieutenant governor and
  the speaker of the house of representatives.
         SECTION 3.  (a)  Not later than January 1, 2012, the
  executive commissioner of the Health and Human Services Commission
  shall adopt the rules necessary to implement Chapter 113,
  Occupations Code, as added by this Act.
         (b)  Notwithstanding Chapter 113, Occupations Code, as added
  by this Act, a person is not required to hold a diagnostic imaging
  facility certificate of registration to operate a diagnostic
  imaging facility until March 1, 2012.
         SECTION 4.  Subchapter B-1, Chapter 113, Occupations Code,
  as added by this Act, applies only to a referral or diagnostic
  imaging service that occurs on or after the effective date of this
  Act. A referral or service that occurs before the effective date of
  this Act is governed by the law as it existed immediately before the
  effective date of this Act, and that law is continued in effect for
  that purpose.
         SECTION 5.  This Act takes effect September 1, 2011.