By: Duncan S.B. No. 1661
(In the Senate - Filed March 11, 2011; March 23, 2011, read
first time and referred to Committee on State Affairs;
April 13, 2011, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 9, Nays 0; April 13, 2011,
sent to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 1661 By: Duncan
A BILL TO BE ENTITLED
AN ACT
relating to the regulation of health organizations certified by the
Texas Medical Board; imposing an administrative penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 162, Occupations Code, is
amended by adding Sections 162.0021, 162.0022, 162.0023, and
162.0024 to read as follows:
Sec. 162.0021. INTERFERENCE WITH PHYSICIAN'S PROFESSIONAL
JUDGMENT PROHIBITED. A health organization certified under Section
162.001(b) may not interfere with, control, or otherwise direct a
physician's professional judgment in violation of this subchapter
or any other provision of law, including board rules.
Sec. 162.0022. HEALTH ORGANIZATION POLICIES. (a) A health
organization certified under Section 162.001(b) shall adopt,
maintain, and enforce policies to ensure that a physician employed
by the health organization exercises independent medical judgment
when providing care to patients.
(b) The policies adopted under this section must include
policies relating to:
(1) credentialing;
(2) quality assurance;
(3) utilization review; and
(4) peer review.
(c) The policies adopted under this section, including any
amendments to the policies, must be developed by the board of
directors or board of trustees, as applicable, of the health
organization and approved by an affirmative vote.
(d) The policies of the health organization must be drafted
and interpreted in a manner that reserves the sole authority to
engage in the practice of medicine to a physician participating in
the health organization, regardless of the physician's employment
status with the health organization.
Sec. 162.0023. DISCIPLINARY ACTION RESTRICTION. A
physician employed by a health organization certified under Section
162.001(b) retains independent medical judgment in providing care
to patients, and the health organization may not discipline the
physician for reasonably advocating for patient care.
Sec. 162.0024. CONTRACTUAL WAIVER PROHIBITED. (a) The
requirements of this subchapter may not be voided or waived by
contract.
(b) Notwithstanding Subsection (a), a member of a health
organization certified under Section 162.001(b) may establish
ethical and religious directives and a physician may contractually
agree to comply with those directives.
SECTION 2. 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 is established,
organized, or operated in violation of or with the intent to violate
this subtitle, the board may:
(1) [may] refuse to certify the health organization on
application for certification by the organization under Section
162.001; [and]
(2) [shall] 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 3. (a) Except as provided by Subsection (b) of
this section, this Act takes effect September 1, 2011.
(b) Section 162.0022, Occupations Code, as added by this
Act, takes effect January 1, 2012.
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