H.B. No. 1532
AN ACT
relating to the regulation of certain health organizations
certified by the Texas Medical Board; providing an administrative
penalty; authorizing a fee.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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 commits a violation of
this subtitle or is established, organized, or operated in
violation of or with the intent to violate this subtitle, the board
may:
(1) refuse to certify the health organization on
application for certification by the organization under Section
162.001;
(2) 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 2. Subchapter A, Chapter 162, Occupations Code, is
amended by adding Sections 162.004, 162.005, and 162.006 to read as
follows:
Sec. 162.004. PROCEDURES FOR AND DISPOSITION OF COMPLAINTS
AGAINST CERTAIN HEALTH ORGANIZATIONS. (a) The board shall accept
and process complaints against a health organization certified
under Section 162.001(b) for alleged violations of this subchapter
or any other provision of this subtitle applicable to a health
organization in the same manner as provided under Subchapter B,
Chapter 154, and the rules adopted under that subchapter, including
the requirements to:
(1) maintain a system to promptly and efficiently act
on complaints filed with the board;
(2) with respect to a health organization that is the
subject of a complaint, notify the health organization that a
complaint has been filed, disclose the nature of the complaint, and
provide the health organization with an opportunity to respond to
the complaint;
(3) ensure that a complaint is not dismissed without
appropriate consideration; and
(4) establish methods by which physicians employed by
a health organization are notified of the name, mailing address,
and telephone number of the board for the purpose of directing
complaints under this section to the board.
(b) Each complaint, adverse report, investigation file,
other investigation report, and other investigative information in
the possession of or received or gathered by the board or the
board's employees or agents relating to a health organization
certified under Section 162.001(b) is privileged and confidential
and is not subject to discovery, subpoena, or other means of legal
compulsion for release to anyone other than the board or the board's
employees or agents involved in the investigation or discipline of
a health organization certified under Section 162.001(b).
(c) The board may dispose of a complaint or resolve the
investigation of a complaint under this section in a manner
provided under Subchapter A, Chapter 164, to the extent the board
determines the provisions of that subchapter can be made applicable
to a health organization certified under Section 162.001.
(d) This section does not require an individual to file or
prohibit an individual from filing a complaint against a health
organization certified under Section 162.001(b) directly with the
health organization, alone or in connection with a complaint filed
with the board under this section, relating to:
(1) the care or services provided by, or the policies
of, the health organization; or
(2) an alleged violation by the health organization of
this subchapter or any other provision of this subtitle applicable
to the health organization.
Sec. 162.005. ANTI-RETALIATION POLICY. (a) A health
organization certified under Section 162.001(b) shall develop,
implement, and comply with an anti-retaliation policy for
physicians under which the health organization may not terminate,
demote, retaliate against, discipline, discriminate against, or
otherwise penalize a physician for:
(1) filing in good faith a complaint under Section
162.004;
(2) cooperating in good faith with an investigation or
proceeding of the board relating to a complaint filed under Section
162.004; or
(3) communicating to a patient in good faith what the
physician reasonably believes to be the physician's best,
independent medical judgment.
(b) On a determination that a health organization certified
under Section 162.001(b) has failed to develop, implement, or
comply with a policy described by Subsection (a), the board may take
any action allowed under this subtitle or board rule applicable to a
health organization.
Sec. 162.006. BIENNIAL REPORT REQUIRED FOR CERTAIN HEALTH
ORGANIZATIONS. (a) Each health organization certified under
Section 162.001(b) shall file with the board a biennial report in
September of each odd-numbered year if the organization was
certified in an odd-numbered year or in September of each
even-numbered year if the organization was certified in an
even-numbered year. The biennial report must include:
(1) a statement signed and verified by the president
or chief executive officer of the health organization that:
(A) provides the name and mailing address of:
(i) the health organization;
(ii) each member of the health
organization, except that if the health organization has no
members, a statement indicating that fact;
(iii) each member of the board of directors
of the health organization; and
(iv) each officer of the health
organization; and
(B) discloses any change in the composition of
the board of directors since the date of the most recent biennial
report;
(2) a statement signed and verified by the president
or chief executive officer of the health organization that:
(A) indicates whether the health organization's
certificate of formation or bylaws were amended since the date of
the most recent biennial report;
(B) if applicable, provides a concise
explanation of the amendments and states whether the amendments
were recommended or approved by the board of directors; and
(C) has attached to the statement a copy of the
organization's current certificate of formation and bylaws if a
copy is not already on file with the board;
(3) a statement from each current director of the
health organization, signed and verified by the director:
(A) stating that the director is licensed by the
board to practice medicine, is actively engaged in the practice of
medicine, and has no restrictions on the director's license;
(B) stating that the director will, as a
director:
(i) exercise independent judgment in all
matters, specifically including matters relating to credentialing,
quality assurance, utilization review, peer review, and the
practice of medicine;
(ii) exercise best efforts to cause the
health organization to comply with all relevant provisions of this
subtitle and board rules; and
(iii) immediately report to the board any
action or event the director reasonably and in good faith believes
constitutes a violation or attempted violation of this subtitle or
board rules;
(C) identifying and concisely explaining the
nature of each financial relationship the director has, if any,
with a member, another director, or a supplier of the health
organization or an affiliate of those persons; and
(D) stating that the director has disclosed all
financial relationships described by Paragraph (C); and
(4) a statement signed and verified by the president
or chief executive officer of the health organization indicating
that the health organization is in compliance with the requirements
for continued certification provided by this subtitle and board
rules.
(b) A health organization required to submit a biennial
report under Subsection (a) shall submit with the report a fee in
the amount prescribed by board rule.
(c) Not later than January 1 of each year, the board shall
publish on the board's Internet website the information provided to
the board in each statement under Subsection (a)(1).
(d) Information provided to the board in each statement
under Subsections (a)(2), (3), and (4) is public information
subject to disclosure under Chapter 552, Government Code.
(e) The board may adopt rules necessary to implement this
section.
SECTION 3. Section 162.003, Occupations Code, as amended by
this Act, and Section 162.004, Occupations Code, as added by this
Act, apply only to a violation by a health organization that occurs
on or after the effective date of this Act. A violation that occurs
before the effective date of this Act is governed by the law in
effect on the date the violation occurred, and the former law is
continued in effect for that purpose.
SECTION 4. Not later than December 31, 2019, a health
organization certified under Section 162.001(b), Occupations Code,
shall develop the anti-retaliation policy required by Section
162.005, Occupations Code, as added by this Act.
SECTION 5. (a) Except as provided by Subsection (b) of this
section, this Act takes effect September 1, 2019.
(b) Section 162.005(b), Occupations Code, as added by this
Act, takes effect January 1, 2020.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1532 was passed by the House on May 2,
2019, by the following vote: Yeas 134, Nays 4, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1532 was passed by the Senate on May
22, 2019, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor