85R29808 BEE-D
By: Buckingham, et al. S.B. No. 1148
(Bonnen of Galveston, Darby, et al.)
Substitute the following for S.B. No. 1148: No.
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 health 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 an individual 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 with whom a managed
care plan issuer contracts to:
(1) process or pay claims;
(2) obtain the services of physicians to provide
health care services to enrollees; or
(3) issue verifications or preauthorizations.
Sec. 1461.003. DISCRIMINATION BASED ON MAINTENANCE OF
CERTIFICATION. (a) Except as provided by Subsection (b), a
managed care plan issuer may not differentiate between physicians
based 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.
(b) A managed care plan issuer may differentiate between
physicians based on a physician's maintenance of certification only
if the designation under law or certification or accreditation by a
national certifying or accrediting organization of an entity
described by Section 151.0515(a), Occupations Code, is contingent
on the entity requiring a specific maintenance of certification by
physicians seeking staff privileges or credentialing at the entity.
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 requirements
that are required for a physician to maintain certification after
initial certification from:
(A) a medical specialty member board of the
American Board of Medical Specialties;
(B) a medical specialty member board of the
American Osteopathic Association Bureau of Osteopathic
Specialists;
(C) the American Board of Oral and Maxillofacial
Surgery; or
(D) any other certifying board that is recognized
by the Texas Medical Board.
SECTION 3. Subchapter B, Chapter 151, Occupations Code, is
amended by adding Sections 151.0515 and 151.057 to read as follows:
Sec. 151.0515. DISCRIMINATION BASED ON MAINTENANCE OF
CERTIFICATION. (a) Except as provided by Subsection (b), the
following entities may not differentiate between physicians based
on a physician's maintenance of certification:
(1) a health facility that is licensed under Subtitle
B, Title 4, Health and Safety Code, or a mental hospital that is
licensed under Chapter 577, Health and Safety Code, if the facility
or hospital has an organized medical staff or a process for
credentialing physicians;
(2) a hospital that is owned or operated by this state;
(3) an institution or program that is owned, operated,
or licensed by this state, including an institution or program that
directly or indirectly receives state financial assistance, if the
institution or program has an organized medical staff or a process
for credentialing physicians on its staff; or
(4) an institution or program that is owned, operated,
or licensed by a political subdivision of this state, if the
institution or program has an organized medical staff or a process
for credentialing physicians on its staff.
(b) An entity described by Subsection (a) may differentiate
between physicians based on a physician's maintenance of
certification only if the entity's designation under law or
certification or accreditation by a national certifying or
accrediting organization is contingent on the entity requiring a
specific maintenance of certification by physicians seeking staff
privileges or credentialing at the entity.
Sec. 151.057. RECOGNITION OF ENTITIES TO PROVIDE
MAINTENANCE OF CERTIFICATION; STUDY. (a) The board, using
existing funds, shall study whether to recognize one or more
entities to provide maintenance of certification for physicians in
this state.
(b) In conducting the study under this section, the board
shall consult with appropriate state agencies and other entities,
as determined by the board.
(c) The results of the study under this section shall be
made available through the board's Internet website and other
appropriate means, as determined by the board.
(d) If the study under this section indicates a need for the
board to recognize one or more entities to provide maintenance of
certification for physicians in this state, the board may develop
and implement a program to recognize such entities. The program
must include an assessment of the following as eligibility criteria
for an entity to provide maintenance of certification:
(1) the amount of time and expense required for a
physician to complete the maintenance of certification requirement
and the extent to which the time requirement has an impact on the
physician's ability to participate in medical practice;
(2) the adequacy of the activities required of a
physician in the area of practice improvement; and
(3) the degree to which the maintenance of
certification requirements are relevant to the practice of the
particular medical specialty for which the maintenance of
certification is provided.
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. The Texas Medical Board shall begin the study
required under Section 151.057, Occupations Code, as added by this
Act, not later than January 1, 2018.
SECTION 7. This Act takes effect January 1, 2018.