By: Buckingham, et al. S.B. No. 1148
(In the Senate - Filed February 28, 2017; March 7, 2017,
read first time and referred to Committee on Business & Commerce;
April 24, 2017, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 8, Nays 0; April 24, 2017,
sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR S.B. No. 1148 By: Campbell
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;
authorizing a fee.
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) 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:
(1) if the entity that administers the physician's
maintenance of certification is certified under Chapter 170,
Occupations Code; and
(2) after the issuer considers the physician's:
(A) training;
(B) experience;
(C) competence; and
(D) judgment.
(c) A managed care plan issuer may not differentiate between
physicians based on the entity that administers a physician's
maintenance of certification.
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 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 A, Chapter 151, Occupations Code, is
amended by adding Section 151.006 to read as follows:
Sec. 151.006. CERTIFICATION OF MEDICAL SPECIALTY.
Notwithstanding any other law, a physician is considered a
board-certified medical specialist in this state if the physician
receives initial certification by a medical specialty board,
regardless of the physician's maintenance of certification.
SECTION 4. 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) Except as provided by Subsection (b), 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 on a physician's
maintenance of certification.
(b) An entity described by Subsection (a) may differentiate
between physicians based on a physician's maintenance of
certification only:
(1) if the entity that administers the physician's
maintenance of certification is certified under Chapter 170; and
(2) after the entity considers the physician's:
(A) training;
(B) experience;
(C) competence; and
(D) judgment.
(c) An entity described by Subsection (a) may not
differentiate between physicians based on the entity that
administers a physician's maintenance of certification.
(d) A state agency, including the Health and Human Services
Commission and the Department of State Health Services, may not
require a hospital or other provider to require maintenance of
certification by a physician.
SECTION 5. 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 6. 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 7. Subtitle B, Title 3, Occupations Code, is
amended by adding Chapter 170 to read as follows:
CHAPTER 170. ENTITY CERTIFICATION TO PROVIDE MAINTENANCE OF
CERTIFICATION
Sec. 170.001. CERTIFICATE TO PROVIDE MAINTENANCE OF
CERTIFICATION. (a) The board shall establish a process to issue a
certificate authorizing an entity to provide maintenance of
certification for physicians.
(b) The board by rule shall establish the minimum number of
continuing medical education hours that are required for
maintenance of certification in a particular medical specialty by
an entity under this chapter.
Sec. 170.002. FEES. The board may set a reasonable
application fee for a certificate under this chapter.
Sec. 170.003. APPLICATION FOR CERTIFICATE. (a) The board
shall prescribe the form of an application for a certificate under
this chapter.
(b) The application must require the applicant to provide:
(1) the applicant's legal name, mailing address,
telephone number, and business address;
(2) the particular practice area in which the
applicant will offer maintenance of certification;
(3) the requirements the applicant will impose on a
physician for maintenance of certification; and
(4) the amount of any fees the applicant will charge a
physician for maintenance of certification.
Sec. 170.004. ISSUANCE OF CERTIFICATE. The board shall
issue a certificate under this chapter to an applicant that:
(1) submits an application on the form prescribed by
the board under Section 170.003;
(2) pays the required fee; and
(3) demonstrates to the satisfaction of the board that
the applicant's maintenance of certification program complies with
Sections 170.005 and 170.006.
Sec. 170.005. REQUIREMENTS FOR MAINTENANCE OF
CERTIFICATION. A maintenance of certification program provided by
a holder of a certificate under this chapter:
(1) must require a physician seeking maintenance of
certification to complete at least the minimum number of continuing
medical education hours set by board rule under Section 170.001(b);
and
(2) other than continuing medical education hours, may
not require a physician initially certified by the entity to
complete any educational or testing requirement, including
periodic testing, proprietary self-assessment, or peer evaluation.
Sec. 170.006. PRACTICE IMPROVEMENT PROGRAM. (a) A holder
of a certificate under this chapter shall administer a practice
improvement program to encourage continued improvement within the
medical profession.
(b) A practice improvement program under Subsection (a)
must focus on recent scientific developments, improving patient
safety, patient or population health outcomes, access to health
care, and patient experience, and increasing value in the health
care system.
Sec. 170.007. ADVERTISING AS BOARD-CERTIFIED SPECIALIST. A
physician who holds current maintenance of certification from a
certificate holder under this chapter may advertise that the
physician is a board-certified specialist in the area of medical
specialty in which the physician holds the maintenance of
certification.
SECTION 8. The Texas Medical Board shall adopt rules to
implement Chapter 170, Occupations Code, as added by this Act, not
later than September 1, 2018.
SECTION 9. This Act takes effect January 1, 2018.
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