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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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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 health 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 an individual licensed to |
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practice 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 with whom a managed |
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care 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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health 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 only |
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if the designation under law or certification or accreditation by a |
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national certifying or accrediting organization of an entity |
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described by Section 151.0515(a), Occupations Code, is contingent |
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on the entity requiring a specific maintenance of certification by |
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physicians seeking staff privileges or credentialing at the entity. |
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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 from: |
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(A) a medical specialty member board of the |
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American Board of Medical Specialties; |
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(B) a medical specialty member board of the |
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American Osteopathic Association Bureau of Osteopathic |
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Specialists; |
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(C) the American Board of Oral and Maxillofacial |
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Surgery; or |
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(D) any other certifying board that is recognized |
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by the Texas Medical Board. |
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SECTION 3. Subchapter B, Chapter 151, Occupations Code, is |
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amended by adding Sections 151.0515 and 151.057 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), the |
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following entities may not differentiate between physicians based |
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on a physician's maintenance of certification: |
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(1) a health facility that is licensed under Subtitle |
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B, Title 4, Health and Safety Code, or a mental hospital that is |
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licensed under Chapter 577, Health and Safety Code, if the facility |
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or hospital has an organized medical staff or a process for |
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credentialing physicians; |
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(2) a hospital that is owned or operated by this state; |
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(3) an institution or program that is owned, operated, |
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or licensed by this state, including an institution or program that |
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directly or indirectly receives state financial assistance, if the |
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institution or program has an organized medical staff or a process |
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for credentialing physicians on its staff; or |
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(4) an institution or program that is owned, operated, |
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or licensed by a political subdivision of this state, if the |
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institution or program has an organized medical staff or a process |
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for credentialing physicians on its staff. |
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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 if the entity's designation under law or |
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certification or accreditation by a national certifying or |
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accrediting organization is contingent on the entity requiring a |
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specific maintenance of certification by physicians seeking staff |
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privileges or credentialing at the entity. |
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Sec. 151.057. RECOGNITION OF ENTITIES TO PROVIDE |
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MAINTENANCE OF CERTIFICATION; STUDY. (a) The board, using |
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existing funds, shall study whether to recognize one or more |
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entities to provide maintenance of certification for physicians in |
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this state. |
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(b) In conducting the study under this section, the board |
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shall consult with appropriate state agencies and other entities, |
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as determined by the board. |
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(c) The results of the study under this section shall be |
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made available through the board's Internet website and other |
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appropriate means, as determined by the board. |
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(d) If the study under this section indicates a need for the |
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board to recognize one or more entities to provide maintenance of |
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certification for physicians in this state, the board may develop |
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and implement a program to recognize such entities. The program |
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must include an assessment of the following as eligibility criteria |
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for an entity to provide maintenance of certification: |
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(1) the amount of time and expense required for a |
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physician to complete the maintenance of certification requirement |
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and the extent to which the time requirement has an impact on the |
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physician's ability to participate in medical practice; |
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(2) the adequacy of the activities required of a |
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physician in the area of practice improvement; and |
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(3) the degree to which the maintenance of |
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certification requirements are relevant to the practice of the |
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particular medical specialty for which the maintenance of |
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certification is provided. |
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SECTION 4. 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 5. 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 6. The Texas Medical Board shall begin the study |
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required under Section 151.057, Occupations Code, as added by this |
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Act, not later than January 1, 2018. |
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SECTION 7. This Act takes effect January 1, 2018. |