85R6881 BEE-D
By: Bonnen of Galveston H.B. No. 3216
A BILL TO BE ENTITLED
AN ACT
relating to maintenance of certification by a physician or an
applicant for a license to practice medicine in this state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
by adding Chapter 1461 to read as follows:
CHAPTER 1461. DISCRIMINATION AGAINST PHYSICIAN BASED ON
MAINTENANCE OF CERTIFICATION
Sec. 1461.001. DEFINITIONS. In this chapter:
(1) "Enrollee" means an individual who is eligible to
receive health care services under a managed care plan.
(2) "Maintenance of certification" has the meaning
assigned by Section 151.002, Occupations Code.
(3) "Managed care plan" means a health benefit plan
under which medical care services are provided to enrollees through
contracts with physicians and that requires enrollees to use
participating physicians or that provides a different level of
coverage for enrollees who use participating physicians. The term
includes a health benefit plan issued by:
(A) a health maintenance organization;
(B) a preferred provider benefit plan issuer; or
(C) any other entity that issues a health benefit
plan, including an insurance company.
(4) "Participating physician" means a physician who
has directly or indirectly contracted with a health benefit plan
issuer to provide services to enrollees.
(5) "Physician" means a person licensed to practice
medicine in this state.
Sec. 1461.002. APPLICABILITY. (a) This chapter applies to
a physician regardless of whether the physician is a participating
physician.
(b) This chapter applies to a person to whom a managed care
plan issuer contracts to:
(1) process or pay claims;
(2) obtain the services of physicians to provide
medical care services to enrollees; or
(3) issue verifications or preauthorizations.
Sec. 1461.003. DISCRIMINATION BASED ON MAINTENANCE OF
CERTIFICATION. A managed care plan issuer may not differentiate
between physicians based solely on a physician's maintenance of
certification in regard to:
(1) paying the physician;
(2) reimbursing the physician; or
(3) directly or indirectly contracting with the
physician to provide services to enrollees.
SECTION 2. Section 151.002(a), Occupations Code, is amended
by adding Subdivision (6-b) to read as follows:
(6-b) "Maintenance of certification" means the
satisfactory completion of periodic recertification examinations
required to maintain certification after an initial certification
under a medical specialty member board, including the member boards
of the American Board of Medical Specialties or the specialty
certifying boards of the American Osteopathic Association.
SECTION 3. Subchapter B, Chapter 151, Occupations Code, is
amended by adding Section 151.0515 to read as follows:
Sec. 151.0515. DISCRIMINATION BASED ON MAINTENANCE OF
CERTIFICATION. A hospital, institution, or program that is
licensed by this state, is operated by this state or a political
subdivision of this state, or directly or indirectly receives state
financial assistance may not differentiate between physicians
based solely on a physician's maintenance of certification.
SECTION 4. Section 155.003, Occupations Code, is amended by
amending Subsection (d) and adding Subsection (d-1) to read as
follows:
(d) Except as provided by Subsection (d-1), in [In] addition
to the other requirements prescribed by this subtitle, the board
may require an applicant to comply with other requirements that the
board considers appropriate.
(d-1) The board may not require maintenance of
certification by an applicant for the applicant to be eligible for a
license under this chapter.
SECTION 5. Section 156.001, Occupations Code, is amended by
adding Subsection (f) to read as follows:
(f) The board may not adopt a rule requiring maintenance of
certification by a license holder for the license holder to be
eligible for an initial or renewal registration permit.
SECTION 6. This Act takes effect September 1, 2017.