Bill Text: TX SB1148 | 2017-2018 | 85th Legislature | Enrolled
Bill Title: Relating to maintenance of certification by a physician or an applicant for a license to practice medicine in this state.
Spectrum: Strong Partisan Bill (Republican 13-1)
Status: (Passed) 2017-06-15 - Effective on 1/1/18 [SB1148 Detail]
Download: Texas-2017-SB1148-Enrolled.html
S.B. No. 1148 |
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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 [ |
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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 |