S.B. No. 1148
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 Section 151.0515 to read as follows:
Sec. 151.0515. DISCRIMINATION BASED ON MAINTENANCE OF
CERTIFICATION. (a) Except as otherwise provided by this section,
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:
(A) has an organized medical staff or a process
for credentialing physicians on its staff; and
(B) is not a medical school, as defined by
Section 61.501, Education Code, or a comprehensive cancer center,
as designated by the National Cancer Institute; 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 if:
(1) 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; and
(2) the differentiation is limited to those physicians
whose maintenance of certification is required for the entity's
designation, certification, or accreditation as described by
Subdivision (1).
(c) An entity described by Subsection (a) may differentiate
between physicians based on a physician's maintenance of
certification if the voting physician members of the entity's
organized medical staff vote to authorize the differentiation.
(d) An authorization described by Subsection (c) may:
(1) be made only by the voting physician members of the
entity's organized medical staff and not by the entity's governing
body, administration, or any other person;
(2) subject to Subsection (e), establish terms
applicable to the entity's differentiation, including:
(A) appropriate grandfathering provisions; and
(B) limiting the differentiation to certain
medical specialties; and
(3) be rescinded at any time by a vote of the voting
physician members of the entity's organized medical staff.
(e) Terms established under Subsection (d)(2) may not
conflict with a maintenance of certification requirement
applicable to the entity's designation under law or certification
or accreditation by a national certifying or accrediting
organization.
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 January 1, 2018.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1148 passed the Senate on
April 27, 2017, by the following vote: Yeas 31, Nays 0;
May 25, 2017, Senate refused to concur in House amendments and
requested appointment of Conference Committee; May 26, 2017, House
granted request of the Senate; May 28, 2017, Senate adopted
Conference Committee Report by the following vote: Yeas 30,
Nays 1.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1148 passed the House, with
amendments, on May 24, 2017, by the following vote: Yeas 140,
Nays 4, one present not voting; May 26, 2017, House granted request
of the Senate for appointment of Conference Committee;
May 28, 2017, House adopted Conference Committee Report by the
following vote: Yeas 144, Nays 2, two present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor